B

CC11 Implement toileting programmes for individuals

Overview

This standard covers the implementation of appropriate toileting programmes for individuals. It involves identifying suitable individuals who would benefit from toileting programmes and identifying the most suitable toileting programmes for them. It also involves providing psychological support, information and advice to individuals involved in toileting programmes.

Users of this standard will need to ensure that practice reflects up to date information and policies.

Version No 1

Knowledge and Understanding

You will need to know and understand:

  1. the current European and National legislation, national guidelines, organisational policies and protocols in accordance with clinical/corporate governance which affect your work practice in relation to implementing toileting programmes
  2. the importance of working within your sphere of competence and when to seek advice if faced with situations outside of your sphere of competence
  3. the importance of applying standard precautions for infection control and the potential consequences of poor practice
  4. the importance of documentation, the data protection act, care of records and disclosure of information with consent from the individual and your employer and the legal and professional consequences of poor practice
  5. the anatomy and physiology of the male and female lower urinary tract in relation to lower urinary tract function and continence status including:
    1. urine production and what influences this
    2. normal micturition
    3. the nervous system, including autonomic dysreflexia
    4. the bowel and its links to bladder problems
    5. the pelvic floor muscles
    6. endocrine
    7. sexual function and links to bladder problems
    8. the prostate gland, urethral sphincters and the urethra
    9. applied anatomy and physiology to bladder over activity and how toileting programmes could be used to relieve this
  6. how to identify the causes of bladder over activity and urinary urgency
  7. how to make a differential diagnosis following a continence assessment
  8. how to select from an assessment of an individual an appropriate toileting programme
  9. how to identify individuals with cognitive impairment and select appropriate toileting programmes
  10. how to obtain valid consent and how to confirm that sufficient information has been provided on which to base this judgement.
  11. how to use terminology that is appropriate for individuals in relation to toilet usage and also adapt this for professionals
  12. how to agree a programme of toileting with follow up and support
  13. what written information on toileting programmes to provide for the individual and where this is obtained from
  14. how and where to refer an individual when a toileting programme has not proved effective and symptoms remain unchanged
  15. the importance of adaptations to the environment to assist individuals to access toilets
  16. the types of toileting charts, number of days used for, frequency of usage, how to use them.
  17. the differences between the types of toileting charts, when to use each of them, the information that will be provided and how to use this therapeutically
  18. how to identify specific data from toileting charts to evaluate the effectiveness of the toileting programme and combined interventions
  19. the disadvantages associated with the use of toileting charts
  20. the range of interventions that will enhance the outcomes of a toileting programme including, caffeine restriction, antimuscarinic medication, alarms and toileting devices
  21. how to combine a range of other interventions with a toileting programme for a specific individual
  22. how certain categories of medication can cause both urinary urgency and/or bladder dysfunction
  23. how individuals’ current medication can cause urinary urgency and/or bladder dysfunction
  24. the indications, mode of action, side-effects, cautions, contra indications and potential interactions of medication (antimuscarinics in particular) used to treat individuals with urinary urgency and/or bladder dysfunction

Performance Criteria

You must be able to do the following:

  1. apply standard precautions for infection prevention and control and take other appropriate health and safety measures
  2. identify suitable individuals who would benefit from a toileting programme
  3. obtain the individual’s valid consent for the toileting programme
  4. use the results of toileting charts to inform the most suitable toileting programme for the individual
  5. review the individual’s use of medication to inform the requirements of the toileting programme
  6. develop a suitable management plan for the specific toileting programme
  7. identify expected outcomes from toileting programmes
  8. ensure toileting programmes are effective by combining with other interventions
  9. provide psychological support to individuals as part of a specific toileting programme
  10. offer regular contact for support and encouragement with toileting programmes to maintain motivation
  11. monitor the effectiveness of the toileting programme using the appropriate tools
  12. provide suitable information and advice to individuals and relevant others
  13. initiate timely onward referral and consultation for an individual if the toileting programme proves ineffective
  14. record clearly, accurately, and correctly any relevant information in the ongoing individual’s care records

Additional Information

This National Occupational Standard was developed by Skills for Health in partnership with the Royal College of Nursing in December 2007.

This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004):

Dimension: HWB5 Provision of care to meet health and wellbeing needs
CC11 Implement toileting programmes for individuals
Final version approved June 2010 © copyright Skills For Health
For competence management tools visit tools.skillsforhealth.org.uk
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