1. Incontinence is highly prevalent among nursing home residents.(Flanagan et al. 2013) Prompted voiding at specific identified times is a common clinical practice and used in the management of urinary incontinence, however, little research is found on the effectiveness of toileting programs in decreasing urinary tract infections in the nursing home population. Urinary tract infections are currently part of the CMS Quality Measure initiative. Nursing home quality measures provide an indication of how well a nursing home provides care for its residents. The purpose of this study is to determine the effect of prompted toileting schedules in postmenopausal women residing in nursing homes in prevention of recurrent urinary tract infections. In the United States a rapidly growing segment of the population is 85 years and older. Many of this population resides in long term care facilities of which over half of the female population is incontinent of urine. Urinary incontinence (UI) is common and may be closely related with functional disability. Impaired mobility is common and can prevent independent toileting. Cognitive impairments also contribute by interfering with a persons ability to recognize the need to toilet. Predisposing factors of recurrent UTI’s were mentioned by researchers as normal consequences of aging and included: Reduced bladder tone Post void residual urine Bladder or uterine prolapse (Stapleton & Stamm 1997) Furthermore, Risk factors contributing to UTI may be common place in nursing homes and include: Poor toileting hygiene (voiding habits) Inadequate fluid intake Immobility requiring dependence to toilet Despite identified prevalence of urinary incontinence and literature to support the frail elderly responding well to prompted voiding toileting programs in nursing homes (Ouslander 2000), little current research was found correlating use of prompted toileting schedules and its effectiveness in reducing urinary tract infection. The Effect of Toileting Schedules on UTI’s in Women in Nursing Homes. Lois G. Bouren RN NUR 490 – 12S State University of New York Institute of Technology Department of Nursing Introduction Methods Abstract Results / Findings References Acknowledgements We would like to acknowledge the following for their help in making this research possible: Residents and staff of the TBC nursing home as well as the Director of Nursing and Administrator Dr. Kathleen Rourke SUNY IT Characteristics: 10 residents with urinary incontinence All were post menopausal females Average age 84 years ( 83.9) Neurogenic bladder and anatomic abnormality diagnoses were excluded All had one UTI within the last 4 months, yet not in past 30 days at start of the study All scored 3 for always incontinent on the MDS 3.0 assessment All scored 3/2 for toileting on MDS 3.0 assessment Conclusion Data Sources: Electronic search was performed in CINAHL. PubMed and Cochrane Library databases through the Cayan Library system at SUNY IT. Key words: Urinary incontinence, prompted voiding, urinary tract infection, nursing homes. Study design developed: A prospective case review of women in a rural New York nursing home was conducted. Ten residents were identified as appropriate participants for a trial. Five participants were placed in the prompted voiding/toileted group, five were placed in the control group. Residents in the toileted group were toileted upon rising, before and after meals and before bed. ( All times could be no more than 30 minutes prior to or after the identified activity) Residents in the control group were sat on the toilet upon rising and checked for incontinence and changed every 2 hours thereafter. Study Protocol: Prior to the trial, staff on the participatory unit were in serviced at a 2 hour instructional program on urinary incontinence and the toileting protocol to be implemented as well as documentation requirements. CNA’s cared for no more than 2 of the identified participants during the day shift and no more than 3 on the evening shift. Generalized toileting schedules during the overnight hours were not included in the toileting program. Research staff (RS) were present for a portion of each shift to observe and assess compliance to the trial protocol and foster communication. Logs were utilized for documentation including time of toileting, resident response and outcome. These logs were not a part of the medical record. Documentation prompted notes when deviation of schedule was evidenced. Design: 9 research articles were reviewed, of those 2 were descriptive studies, 1 was a prospective case study, 1 was a randomized control trial and 5 were systematic literature reviews 1 of which included randomized controlled trials on bladder training and prompted voiding. (Roe et al. 2006) The RCT used in this systematic review however was dated between 1991 to 1998 further demonstrating lack of current research. Based upon this information the following study was implemented. Thus far, findings of our study are limited to: Frequency of incontinence Number of incontinence episodes within a specific time Number of residents with reductions in incontinence episodes Number of residents with No reduction in incontinence episodes Barriers to prompted voiding/generalized toileting Inconsistent staff Inconsistent assignments Unwillingness to change care routine The number of trials included in systematic reviews and evidence on the effectiveness of voiding programs is limited (Roe et al.2006). Recurrent UTI remains an exceedingly common clinical problem in women of all ages. (Staple & Stamm 1997). Staffing patterns make it difficult to adhere to specific toileting programs in nursing homes (Harke & Richgels 1992) and evidenced in our current study. There is evidence to support decreased incontinent episodes in 3 of the toileted residents thus far compared with no improvement in the control group. No indicators of UTI is evidenced at this preliminary stage of the study in either group. Based upon the information and study thus far further research is needed to determine the effectiveness of generalized toileting schedules on UTI’s in women in nursing homes. Flanagan,L., Roe, B.,Jack,B.,Shaw,C.,WilliamsS., Chung,A.,& Barnett,J.(2013) Factors with the management Of incontinence in older people in care homes, JAN, June 2013 Hagglund,D. (2010) A systematic review of in- Continence care for persons with dementia Journal of Clinical Nursing,19,303-312 Harke,J.,& Richgels,K. (1992)Barriers to implementing A continence program in nursing homes. Clinical Nursing Research Vol.1. No.2 158-168 Johnson,T., Ouslander,J.,Uman, G.,and Schnelle, J.(2001) Urinary incontinence treatment preferences in long term care Journal American Geriatric Society 49:710-718. Ouslander, J. (2000) intractable incontinence in the elderly BJU International 85. Suppl.3.72-78 Ouslander,J., Samarrai,N.,Schnelle,J. (2001) Prompted Voiding for nighttime incontinence in nursing homes: Is It effective? Journal American Geriatric Society Vol.49(6) 706-709 Roe,B.,Ostaszkiewocz,J.,Milne,J.,& Wallace,S. (2006) Systematic reviews of bladder training and voiding programs In adults:a synopsis of findings from data and outcomes Using metastudy techniques.JAN July 2006. Stapleton,A., and Stamm, W. (1997) Prevention of Urinary Tract Infection.Infectious Disease Clinics of North America Vol11.No.3