Steps for Assessment
: H0200A, Trial of a
Toileting Program
The look-back period for this item is since the most recent
admission/entry or reentry or since urinary incontinence was
first noted within the facility.
1. Review the medical record for evidence of a trial of an
individualized, resident-centered toileting program. A
toileting trial should include observations of at least 3 days
of toileting patterns with prompting to toilet and of
recording results in a bladder record or voiding diary.
Toileting programs may have different names, e.g., habit
training/scheduled voiding, bladder rehabilitation/bladder
retraining.
2. Review records of voiding patterns (such as frequency,
volume, duration, nighttime or daytime, quality of stream)
over several days for those who are experiencing
incontinence.
3. Voiding records help detect urinary patterns or intervals
between incontinence episodes and facilitate providing care
to avoid or reduce the frequency of episodes.
4. Simply tracking continence status using a bladder record or
voiding diary should not be considered a trial of an
individualized, resident-centered toileting program.
5. Residents should be reevaluated whenever there is a change
in cognition, physical ability, or urinary tract function.
Nursing home staff must use clinical judgment to determine
when it is appropriate to reevaluate a resident’s ability to
participate in a toileting trial or, if the toileting trial was
unsuccessful, the need for a trial of a different toileting
program.
DEFINITIONS
BLADDER
REHABILITATION/
BLADDER RETRAINING
A behavioral technique that
requires the resident to resist
or inhibit the sensation of
urgency (the strong desire to
urinate), to postpone or delay
voiding, and to urinate
according to a timetable
rather than to the urge to
void.
PROMPTED VOIDING
Prompted voiding includes
(1) regular monitoring with
encouragement to report
continence status, (2) using a
schedule and prompting the
resident to toilet, and (3)
praise and positive feedback
when the resident is
continent and attempts to
toilet.
HABIT TRAINING/
SCHEDULED VOIDING
A behavior technique that
calls for scheduled toileting at
regular intervals on a
planned basis to match the
resident’s voiding habits or
needs.
CHECK AND CHANGE
Involves checking the
resident’s dry/wet status at
regular intervals and using
incontinence devices and
products.
H0200: Urinary Toileting Program (cont.)
Steps for Assessment: H0200B, Response to Trial Toileting Program
1. Review the resident’s responses as recorded during the toileting trial, noting any change in
the number of incontinence episodes or degree of wetness the resident experiences.
Steps for Assessment: H0200C, Current Toileting Program or Trial
1. Review the medical record for evidence of a toileting program being used to manage
incontinence during the 7-day look-back period. Note the number of days during the look-
back period that the toileting program was implemented or carried out.
2. Look for documentation in the medical record showing that the following three requirements
have been met:
•
implementation of an individualized, resident-specific toileting program that was based
on an assessment of the resident’s unique voiding pattern;
•
evidence that the individualized program was communicated to staff and the resident (as
appropriate) verbally and through a care plan, flow records, and a written report; and
•
notations of the resident’s response to the toileting program and subsequent evaluations,
as needed.
3. Guidance for developing a toileting program may be obtained from sources found in
Appendix C.