Occupational therapy’s role in toileting

As an occupational therapist that specializes in bowel and bladder management, when I work with patients on catheter or colostomy management, I often hear from other healthcare professionals, “I didn’t know OT’s did that!”  The occupational therapy profession, like other healthcare disciplines, have evolved and changed over the years.  While most people are aware that occupational therapists work on occupations or activities of daily living (ADLs), most have never taken the time to read what is in the Occupational Therapy Practice Framework.

In order to know what you can and are able to work on as a health care practitioner, you must review your scope of practice, framework as well as any applicable state laws.  The Occupational Therapy Practice Framework 3rd edition defines toileting as: “Obtaining and using toileting supplies, managing clothing, maintaining toileting position, transferring to and from toileting position, cleaning body, and caring for menstrual and continence needs (including catheter, colostomy, and suppository management), as well as completing intentional control of bowel movements and urination and, if necessary, using equipment or agents for bladder control” (uniform data system for medical rehabilitation, 1996, pp iii-20, iii-24).  Notice how specific the framework is and intentional with mentioning catheter, colostomy and suppository management.  Did you know that was there before today?

So what can be done about improving patient outcomes for bowel and bladder management?  Education and interdisciplinary collaboration is the key!  The first step in getting occupational therapists more involved in all of these areas is having them first read their practice framework and be aware that they absolutely can work on catheter, colostomy or suppository management with their patients.  Now, just because you can work on something doesn’t mean you should.  Occupational therapists, and all disciplines for that matter, must get properly trained and establish competency in these areas before including it in their practice.  When you do, I’m confident that you will see like I have that even basic interventions in toileting can make a big difference in patient outcomes.

I encourage everyone to review their scope of practice as you may be surprised to what you find.   And when you do, take the next step by expanding your knowledge and sharing with others.

Jeffrey Despommier, OTR, OMS, CUA, ATP


About the author – Jeffrey is an occupational therapist with over 15 years of rehabilitation experience. He is board certified as a urologic associate and ostomy management specialist.  He also specializes in complex rehab technology and is board certified as an assistive technology professional.

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