Incontinence management

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Modules - Incontinence Management


INDICATORS OF A QUALITY ASSESSMENT

What exactly does a basic resident assessment of urinary incontinence entail? We at the Borun Center worked with other UCLA colleagues and researchers at RAND, a southern California think tank, to develop a series of quality indicators (QI) related to incontinence care for nursing home residents.

Of the nine QIs we generated, three pertain to the assessment process. Presented as a series of if/then statements (so there's no mistaking your obligations), these QIs outline the assessment process:

  1. IF a nursing home resident has urinary incontinence on admission or the new onset of urinary incontinence that persists for over one month,
      THEN a targeted history should be obtained that documents each of the following:
    • Mental status
    • Characteristics of voiding
    • Ability to get to the toilet
    • Prior treatment for urinary incontinence
    • Importance of the problem to the residents

  2. IF a nursing home resident has new urinary incontinence that persists for over one month or urinary incontinence on initial assessment,
      THEN a targeted physical should be performed that documents:
    • Rectal exam
    • Skin exam
    • Genital system exam (including a pelvic exam for women)

  3. IF a nursing home resident has new urinary incontinence that persists for over one month or urinary incontinence on initial assessment,
      THEN the following tests should be obtained or there should be documentation explaining why the test was not completed:
    • Dipstick urinalysis
    • Post-void residual
    • 24-hour voiding record
It should be noted that these QIs are not, technically speaking, practice guidelines, though they are based closely on existing guidelines such as those available from the American Medical Directors Association. Rather, they "set a minimal standard for acceptable care--standards that, if not met, almost ensure that the care is of poor quality (emphasis is ours) (2)."

Based on expert opinion and existing best-practice guidelines, all of our QI-associated assessment tasks are both related to positive outcomes for residents and feasible for nursing home staff to implement. There should be no excuse for not accomplishing them.

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