Incontinence management
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Modules - Incontinence Management
START BY SETTING WETNESS WARNING LIMITS
The primary tool used to monitor prompted voiding programs is a control chart, which graphically displays expected versus actual outcomes. This chart compares the percentage of incontinent residents found wet at any given point in time to the percentage who should be wet if the prompted voiding program is working as expected. If the "actual" percentage exceeds the "expected" percentage, there's a problem, and it needs further analysis if you intend to resolve it. Typical problems stem from changes in a resident's status or break-downs in the prompted voiding work process.
Before you can construct a control chart, you need to establish your program's performance goals; that is, you need to calculate the percentage of residents who should be wet if the program is working well. This calculation is based on data collected during the prompted voiding trial (see Step 2). Only the data for "responsive" residents is used. Recall that during the assessment trial, these residents were checked for wetness four times a day for two or three days. These 8 or 12 "data points" per resident, recorded on the Prompted Voiding Trial form, can now be used to establish program performance goals as follows:
- Calculate the wetness rate for each responsive resident: Divide the total number of checks on which the resident was found wet by the total number of checks in all (8 for a two-day trial; 12 for a three-day trial), then multiply by 100 to convert to a percentage.
- Calculate the average wetness rate for all residents and the standard deviation by using a simple program at this web address: http://www.physics.csbsju.edu/stats/cstats_NROW_form.html. (Alternatively, some calculators can also compute averages and standard deviations.) Where this web-based program prompts you to enter the "Number of Items," enter the number of residents for which you have wetness rates, then click "Submit." In the boxes that appear next, enter the wetness rates for residents, one per box. Then click "Calculate Now."
- The program returns a "results" page that reports both the mean, or average, wetness rate for all residents and the standard deviation. Use these results to set a warning limit two standard deviations above the mean. Suppose, for example, that the mean wetness rate for five residents was 18.8% and the standard deviation was 2.86. With these results, we would set the warning limit at 24.52% [18.8 + 2(2.86)].
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