program of excellence in extended care

• Urinary incontinence
• Urinary retention
• Urinary tract infection

The Program of Excellence is based on the MDS (Minimum Data Set) and CMS Tag F315 surveyor regulations for the assessment of residents with bladder dysfunction, and covers toileting assistance programs, behavior modification strategies, bladder rehabilitation techniques, environmental accommodation, and device and product management.

The Program of Excellence was written by a well-known incontinence expert, Diane K. Newman, a certified nurse practitioner and Co-Director of the Penn Center for Continence and Pelvic Health, Division of Urology, University of Pennsylvania Medical Center, in Philadelphia. She is also an Instructor in the School of Medicine at the University of Pennsylvania and Director of the Incontinence Center at SeekWellness.com.

Ms Newman was a member of the panel of experts of the Center for Medicare and Medicaid Service’s Scope and Severity of Nursing Care Deficiencies in long term care on “Guidance to Surveyors on Incontinence and Catheters-Tag F315.” She was the Co-chair of the 1996 Agency for Healthcare Research and Quality Clinical Practice Guideline on Urinary Incontinence: Acute and Chronic Management. The Program of Excellence reflects the recommendation CMS’s F Tag 315.

Ms. Newman is an internationally known speaker on the topic of urinary incontinence and the use of devices and products for the management of incontinence. She has lectured to state surveyor groups, CMS RAI group, state health care associations, long term care groups such as NADONA, AANAC, and AMDA.

By studying the Program of Excellence manual and completing a post-test, Extended Care staff can receive 5.0 CE credits from SUNA (Society of Urologic Nurses and Associates).

The purpose of the course is to assist Extended Care providers in the development and implementation of a Program of Excellence for residents with bladder disorders; specifically urinary incontinence, urinary retention, and urinary tract infection.

The Program of Excellence in Extended Care is designed to help staff maximize each resident’s bladder function through carefully guided assessment and management. The program is based on standard medical concepts combined with the newest theoretical and practical knowledge. The focus of this program is rehabilitation and the application of technology. State of the art technology for monitoring bladder volume is an integral part of the Program of Excellence.

Based on MDS (Minimum Data Set) and the CMS Tag F315 regulations for the assessment of residents with bladder dysfunction, the Program of Excellence covers toileting assistance programs, behavior modification strategies, bladder rehabilitation techniques, environmental accommodation, and device and product management. It provides information that can be used when educating staff, residents, and family members.

The Program of Excellence in Extended Care has been prepared for you, the bedside nurse, nurse educator, or administrator. Its purpose is two-fold:

1. To provide a self-study program that will increase your knowledge of bladder disorders and their underlying causes in your resident population, and to arm you with up-to-date knowledge of the prospects for evaluating and treating these conditions.
   
   
2. To help you implement a “Train-the-Trainer” staff education module by presenting comprehensive information on urinary incontinence, urinary retention, and urinary tract infections, while providing solutions for effective bladder restoration and management.

The Program of Excellence provides the knowledge your nursing staff needs to care for residents who have been assessed and selected as candidates for bladder rehabilitation and management.

Table of Contents

About the Program of Excellence – Learning Objectives and Continuing Education Statement

Section I: Program of Excellence in an Era of Regulation

• Minimum Data Set Requirements (MDS)
• Resident Assessment Protocol
• Quality Indicators
• References
• CMS Tag F315 Urinary Incontinence and Catheters
• Resident Assessment Protocol – Urinary Incontinence and Indwelling Catheters

Section II: Review of the Urinary System

• Anatomy and Physiology of the Urinary Tract System
• Kidneys and Ureters
• Bladder
• Urethra and Sphincters
• Pelvic Floor Muscles
• Nervous System
• Normal Urination Cycle
• Aging and Changes in the Urinary System

Section III: Understanding Bladder Dysfunction

• Types of Bladder Dysfunction
• Urinary Incontinence
• Classification System for Continence
• Causes and Types
• Urinary Retention
• Causes and Types
• Urinary Tract Infection
• Causes and Types
• Assessment of Bladder Dysfunction
• History
• Physical Examination
• Testing
• Functional and Environmental Assessment
• References
• Program of Excellence in Extended Care

Section IV: Use of the BladderScan® Bladder Volume Instrument

• Description of the Bladder Volume Instrument
• Indications, Goals, Objectives, Benefits, Applications
• Protocols for Use of a Bladder Volume Instrument
• Assessment of the Resident
• Bladder and Bowel Diary
• Intermittent Catheterization Based on Bladder Volume
• Case Study
• Indwelling Catheter Removal
• Case Study
• Behavioral Interventions - Implementing a Toileting Assistance Program
• Habit Training/Scheduled Toileting
• Prompted Voiding
• Case Study
• Obsessive Toileting Behavior
• Case Study
• References

Section V: In-Service Training

• Instructions for BladderScan® Use
• Procedure for Performing Ultrasound
• Summary of References

Section VI: Treatments

• Behavioral Interventions
• Dietary Management
• Techniques to Facilitate Bladder Emptying
• Implementing a Bowel Regimen
• Bladder Retraining
• Pelvic Floor Muscle Exercises
• Drug Therapy Tables-Urge UI, Overactive Bladder Urogenital Atrophy, Bladder Emptying
• References

Section VII: Catheters, Products and Devices

• Catheters – Indwelling Urethral, Suprapubic, and External
• Pelvic Organ Support Device
• Absorbent Products and Skin Care
• Toileting Aids

Glossary of Terms

Obtaining Contact Hours

• How to Obtain Continuing Education Credit for the Program of Excellence
• Post-Test
• Evaluation of the Program of Excellence
  

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