MDS 3.0: Recommended Form - Ucla - GeroNet

Section H Bladder and BowelH1. AppliancesCheck all that applied in last 5 days:a. Indwelling bladder catheterb. External (condom) catheterc. Ostomy (including suprapubic catheter, ileostomy, and colostomy)d. Intermittent catheterizatione. None of the aboveCheck all that apply.H2. Urinary Toileting ProgramEnterCodea. Has a trial of a toileting program (e.g. scheduled toileting, prompted voiding, or bladder training) beenattempted on admission or since urinary incontinence was noted in this facility?0. No Skip to H3, Urinary Continence1. Yes Continue to H2b9. Unable to determine Skip to H2cEnterCodeb. Response—What was the resident’s response to the trial program?0. No improvement1. Decreased wetness2. Completely dry (continent)9. Unable to determine or trial in progressEnterCodec. Current toileting program or trial—Is a toileting program (e.g. scheduled toileting, prompted voiding, orbladder training) currently being used to manage the resident’s urinary continence?0. No1. YesH3. Urinary ContinenceEnterUrinary continence in last 5 days. Select the one category that best describes the resident over the last 5 days:0. Always continentCode1. Occasionally incontinent (less than 5 episodes of incontinence)2. Frequently incontinent (5 or more episodes of incontinence but at least one episode of continent voiding)3. Always incontinent (no episodes of continent voiding)9. Not rated, resident had a catheter (indwelling, condom), urinary ostomy, or no urine output for entire 5 daysH4. Bowel ContinenceEnterBowel continence in last 5 days. Select the one category that best describes the resident over the last 5 days:0. Always continentCode1. Occasionally incontinent (one episode of bowel incontinence)2. Frequently incontinent (2 or more episodes of bowel incontinence, but at least one continent bowelmovement)3. Always incontinent (no episodes of continent bowel movements)9. Not rated, resident had an ostomy or did not have a bowel movement for the entire 5 daysH5. Bowel Toileting ProgramEnterIs a toileting program currently being used to manage the resident’s bowel continence?0. NoCode1. YesH6. Bowel PatternsEnterConstipation present in the past 5 days?0. NoCode1. YesRecommended MDS 3.0 16