In most care settings, maintaining continence and minimizing incontinence is an important part of managing clients’ elimination needs. Toileting routines are an important part of meeting these needs, especially for those who require minimal to full assistance with the toileting activity.
There are many benefits to maintaining a toileting routine with clients. They include, but are not limited to:
- Maintaining continence
- Comfort
- Dignity
- Reducing the incidence of constipation
- Reducing the incidence of UTI’s
- Reducing the incidence of falls
- Reducing the effects of incontinence on skin and skin related issues
As a client’s ability to mobilize decreases and assistance with care needs increases, toileting may become more challenging with timelines and the way that the activity occurs. If a client now requires a lift and sling to accomplish this, toileting can still be a part of the activities of daily living with use of a universal sling. A universal sling may be used if the client requires optimal support during the transfer, if they do not meet the criteria to use a hygiene (toileting) sling, or a hygiene sling is not available for use. Clients must meet the criteria for using a universal sling: no amputations above the knee, medically able to sit and/or use the universal sling and no individual contraindications identified.
If it is determined through an interdisciplinary assessment that toileting is no longer effective for the client (e.g. complete incontinence), consideration may be directed toward implementing a changing routine instead of a toileting routine.
The following are considerations and guidelines to help in the facilitation of toileting with a universal sling and lift:
Considerations for Using a Universal Sling for Toileting
If a client is now requiring the use of a universal sling for toileting, it is optimal to set up the client and caregivers for success with this task, which may in turn spare the client discomfort and anxiety relating to their elimination needs.
Effective and Reliable Communication of Elimination Needs
Issue(s)
If the client cannot communicate their elimination needs, it may be difficult for staff to meet those needs effectively. Timeline is also a factor with this communication to ensure successful toileting.
What You Can Do?
- Assess cognitive and communication abilities for reliability
- If client able to reliably communicate elimination needs, discuss with client and develop toileting plan around identified needs
- If client unable to verbalize, assess elimination schedule to determine if there is consistencies or patterns to assist in developing an individualized toileting plan.
Clothing
Issue(s)
If clothing is too tight or difficult to remove and replace, this may delay the timely process of toileting and may cause discomfort for client.
What You Can Do?
- Discuss with client and/or family to consider purchase of adaptive clothing (pants) to influence ease and timeliness of toileting – particularly if there are joint mobility issues (e.g. contractures), pain, obesity or resistive behaviors. Other clothing items (tops) may be considered based on the client’s needs.
- Assess clothing to ensure proper/loose fit; discuss with client and/or family to bring appropriate clothing (loose, elasticized waistbands, stretch material) and remove those that may impede safe and timely toileting.
Sling
Issue(s)
Proper sizing and placement under client are essential. If sling placement under client in chair is challenging for staff, this may impact the timeliness of the toileting, as well as comfort for the client with the sling application and/or ill placed sling.
What You Can Do?
- Ensure sling is properly sized using the High Star sling sizing chart as a guide.
- If sling application is challenging for staff and/or client, through interdisciplinary consultation, consider leaving sling made from spacer fabric (black) under client while up in chair unless there are contraindications to same. Other tools, such as low friction sheets may be used to assist in sling application. Consult with your Clinical Support for assistance
Incontinent Products
Issue(s)
Incontinent products may need to be in place up until the client is settled on the toilet or commode. Staff will need full access to client to replace product properly once toileting completed.
What You Can Do?
- Ensure the incontinent product is accessible for removal for ease and timelines of toileting (e.g. side tape fasteners)
- It may be optimal to manually hold a product in place until just before client settled on the commode or toilet. The act of the lift may hasten elimination for client.
- Clients will require transfer to lying surface for proper replacement of incontinent products once toileting completed.
Guidelines for Toileting with a Universal Sling
** Always inform client of what is going to happen during each step. Ask them to assist with the process as able. **
Non Adaptive Clothing
1. Prepare the Client
If client in bed, remove or lower pants as well as underwear and/or incontinent product. Remove or tuck incontinent product down for easy removal.
2. Apply the Sling
As per Universal Sling user instructions
3. Connect Sling to Ceiling or Floor lift
As per Universal Sling user instructions and lift user manual
4. Lift Client
- Use lift as per lift user manual
- Transfer client to rest on commode or toilet if access with lift is available and safe. Remove incontinent product prior to setting down.
5. Post Toileting
- Address client hygiene
- Connect sling to lift
- Transfer client to bed
- Replace incontinent product and/or underwear and pants
- If client to be transferred to another surface, reapply the sling and proceed to transfer using lift
- Remove sling when client is settled
Non Adaptive Clothing, If client in chair
Far far away, behind the word mountains, far from the countries Vokalia and Consonantia, there live the blind texts. Separated they live in Bookmarksgrove right at the coast of the Semantics, a large language ocean.
Adaptive Clothing
Far far away, behind the word mountains, far from the countries Vokalia and Consonantia, there live the blind texts. Separated they live in Bookmarksgrove right at the coast of the Semantics, a large language ocean.