H0500: Bowel Toileting Program

H0500: Bowel Toileting Program

Item Rationale

Health-related Quality of Life

A systematically implemented bowel toileting program may decrease or prevent bowel incontinence, minimizing or avoiding the negative consequences associated with incontinence.

Many incontinent residents respond to a bowel toileting program, especially during the day.

Planning for Care

If the bowel toileting program leads to a decrease or resolution of incontinence, the program should be maintained.

If bowel incontinence is not decreased or resolved with a bowel toileting trial, consider whether other reversible or treatable causes are present.

Residents who do not respond to a bowel toileting trial and for whom other reversible or treatable causes are not found should receive supportive management (such as a regular check and change program with good skin care).

Residents with a colostomy or colectomy may need their diet monitored to promote healthy bowel elimination and careful monitoring of skin to prevent skin irritation and breakdown.

When developing a toileting program the provider may want to consider assessing the resident for adequate fluid intake, adequate fiber in the diet, exercise, and scheduled times to attempt bowel movement (Newman, 2009).

Steps for Assessment

Review the medical record for evidence of a bowel toileting program being used to manage bowel incontinence during the 7-day look-back period.

Look for documentation in the medical record showing that the following three requirements have been met:

implementation of an individualized, resident-specific bowel toileting program based on an assessment of the resident’s unique bowel pattern;

evidence that the individualized program was communicated to staff and the resident (as appropriate) verbally and through a care plan, flow records, verbal and a written report; and

notations of the resident’s response to the toileting program and subsequent evaluations, as needed.

Coding Instructions

Code 0, no: if the resident is not currently on a toileting program targeted specifically at managing bowel continence.

Code 1, yes: if the resident is currently on a toileting program targeted specifically at managing bowel continence.