Key Quality Measure Insights for Improved Catheter Care

The Quality Measure for Residents Who Have/Had a Catheter Inserted and Left in Their Bladder is a long-stay measure.  This measure impacts Care Compare and Five-Star.

This measure looks at the percentage of residents who have had an indwelling catheter in the last 7 days.

The numerator for the measure is the number of long-stay residents with a selected target assessment indicating the use of an indwelling catheter.  This is reported in H0100A.

The denominator is the all long-stay residents with a selected target assessment, except for those that meet the exclusion criteria. Exclusion criteria for this measure includes target assessments that:

• Are admission assessments (A0310A = 01) OR PPS 5-day assessments (A0310B = 01).
• Do not report indwelling catheter status [H0100A= (-)].
• Note neurogenic bladder (I1550 = 1) or neurogenic bladder status is missing [I1550 = (-)].
• Indicate obstructive uropathy (I1650 = 1) or obstructive uropathy status is missing [I1650 = (-)].

Covariates for risk adjustment for this measure include:

• Frequent bowel incontinence on prior assessment (H0400= 2 or 3)
  
  1. Covariate= 1 if H0400 is 2 or 3
  2. Covariate= 0 if H0400 is 0, 1, 9 or (-)
• Pressure ulcers at stages II, III, or IV on prior assessment
  1. Covariate = 1 if any of the following are true
     
     • M0300B1 = 1, 2, 3, 4, 5, 6, 7, 8, or 9; or,
     • M0300C1 = 1, 2, 3, 4, 5, 6, 7, 8, or 9; or,
     • M0300D1 = 1, 2, 3, 4, 5, 6, 7, 8, or 9.
  2. Covariate = O if the following is true
     • M0300B1 = 0, (-), or ^; and,
     • M0300C1 = 0, (-), or ^; and,
     • M0300D1 = 0, (-), or ^.
• All covariates are missing if no prior assessment is available

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State Surveyors use the Urinary Catheter or UTI Critical Element Pathway (CMS-20068) when reviewing facility performance.  Aspects reviewed include comprehensive assessments focused on Section C, GG, H, I, and M of the MDS, Physician orders, pertinent diagnoses, and care planning.   Staff assistance and interventions are observed across shifts. Interviews are conducted across shifts with residents, their representatives, and family and with staff.  Failure to comply can lead to various F-tags.

An Interdisciplinary Team approach should be utilized to address catheter use, including:

• Perform bladder evaluation assessments per policy and implement interventions as appropriate (i.e., toileting program).
• Indication if the catheter remains due to urinary retention.
• Review of diagnoses to determine if a diagnosis supporting catheter use should be added by the physician, as neurogenic bladder and obstructive uropathy can have numerous root causes.
  1. Neurogenic bladder: CVA, MS, Neurological trauma, Parkinson’s Disease, Alzheimer’s Disease, and DM
  2. Obstructive Uropathy: BPH, urethral stricture, diabetic neuropathy, renal failure, or trauma
• Monitor staff providing perineal/catheter care for infection prevention.
• Review monthly those residents who have a catheter in place.
• Determine if straight catheterization is able to be completed versus use of an indwelling catheter.
• Monitor skin integrity healing to determine if a catheter may be removed.
• Use a bladder scanner for residual checks before and during catheter removal to assess residual volumes.
• Consider alternative devices, i.e., condom catheter or Purewick^TM System.
• Potentially complete another MDS assessment when an indwelling catheter is discontinued.

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Initial and continual assessment of the resident’s condition in relation to catheter use is vital to decrease the risk of infection and improve overall quality of life.