Catheter script SLIDE 1- My name is Maureen Valvo I am a Sr
Contents
1. outlet obstruction assist with healing open sacral or perineal wounds 4of5 Cath script Leave catheters in place only as long as needed remove catheters as soon as possible Avoid use in elderly and Avoid use with Impaired Immunity and Avoid use for management of incontinence Alternatives to Indwelling Catheterization Intermittent catheterization maybe use of bladder ultrasound scanners to identify urine retention External condom catheters are consider for Cooperative male patients without obstruction or urinary retention SLIDE 12 Implement QI programs to enhance appropriate use of indwelling catheters Examples Alerts or reminders in Nursing Homes this is usually documented on the Treatment record Stop orders usual in nursing homes this is part of the admission assessment to immediately question the need for catheter and an immediate plan to remove Protocols for nurse directed removal of unnecessary catheters SLIDE 13 Model for Improvement Next Steps Using the resident level list of who triggered the QM Begin with MDS Accuracy review sections H Bladder Bowel Section I Active Diagnoses and Section M Skin Conditions specifically pressure ulcers affects Catheter QM Review what was presented Quality Measure specifications Quality Measure User Manual and MDS 3 0 RAI Manual To know requirements to ensure that coding is accurate Electronic medical record EMR electronic MDS co2. Cath script Catheter script SLIDE 1 My name is Maureen Valvo I am a Sr Quality Improvement Specialist on the IPRO Nursing Home Team in the Health Care Quality Improvement department will review the Long Stay Quality Measure the Percent of Residents Who Have Had a Catheter Inserted Left in Their Bladder SLIDE 2 The Objectives of this webinar are to e TO Review Become familiar with the QM specifications e TO Understand how MDS coding in Sections H Bladder and Bowel Section I Active Diagnoses and Section M Skin Conditions convert to the Quality Measure the Percent of Residents Who Have Had a Catheter Inserted Left in Their Bladder e Last I will discuss the Model for Improvement and Next Steps how to use this information SLIDE 3 This quality measure is a long stay quality measure meaning the resident has cumulative days in facility of more than or equal to 101 days If the resident has been in your facility 101 days or more and that includes in and out days but only counts the days actually in the facility then they are going to be in the long stay quality measure There are short stay measures based on a calculation that of 100 days or less But these are mutually exclusive A resident on any given report is only considered a long stay resident or a short stay resident but not both for that report 1of5 Cath script SLIDE 4 This Quality Measure is used in the e CMS CASPER Quality Measure Report e Nur
3. ephrostomy tube is checked The last items must be checked or status missing skipped will be triggered For additional information please view the CASPER webinar on our IPRO website SLIDE 7 This slide is a screen shot of the casper report highlighting the one QM Cath insert left Bladder long term On the Casper Report the residents in the numerator triggered the QM have catheters The denominator is all long stay target assessments except for the just mention exclusions The last column is the national percentile ranking the closer to zero the better For additional information please view the CASPER webinar on our IPRO website SLIDE 8 This is a screen shot of the QM Resident level list highlighting a resident that triggers for catheter They also trigger behavior symptoms affecting others on the Quarterly MDS Immediately ask Why is the catheter being used since the resident does not have the diagnosis of neuropathic bladder or obstructive uropathy The use of the catheter may be uncomfortable and painful Is that being addressed or is it causing the behavior symptoms affecting others Use this resident list for a record review Why does the resident have a catheter Is the MDS coded correctly Slide 9 From The RAI manual DEFINITIONS for coding section H INDWELLING CATHETER A catheter that is maintained within the bladder for the purpose of continuous drainage of urine 30f5 Cath script SUPRAPUBIC CATHETER An indwe
4. lling catheter that is placed by a urologist directly into the bladder through the abdomen when there is an obstruction to urine flow NEPHROSTOMY TUBE A catheter inserted through the skin into the kidney in individuals with an abnormality of the ureter or the bladder If a resident has used any of these 3 items used in the last 7 days then indwelling catheter item would be checked Slide 10 Reviewing the MDS RAI Manual regarding catheters It is important to know what appliances are in use and the history and rationale for such use Indwelling catheters should not be used unless there is valid medical justification Assessment should include consideration of the risk and benefits of a catheter the anticipated duration of use and consideration of POTENTIAL complications resulting from the use of an indwelling catheter Complications can include an increased risk of urinary tract infection blockage of the catheter with associated leakage around the catheter expulsion of the catheter pain discomfort and bleeding Slide 11CENTER FOR DISEASE CONTROL Core Prevention Strategies CDC Background Urinary Catheter Use e 15 25 of hospitalized patients e 5 10 75 000 150 000 Nursing Home residents e Often placed for inappropriate indications e Physicians frequently unaware how long they remain in place CDC suggested Core Prevention Strategies Insert catheters only for appropriate indications acute urinary retention bladder
5. mpletion are there point and click issues Verify medical record documentation supports coding Related to the Assessment Reference Date ARD eAssess the effect of staff stability consistent assignment practice with accurately identifying and developing individualized care plans 5of5 Cath script Do Root Cause Analysis The 5 Whys Plan for improvement So what are we trying to accomplish And then what change can we make that will result in an improvement How will we know that it changes an improvement Use the PLAN DO STUDY ACT model Was that test of change successful Do we need to do something different Do we need to test it further SLIDE 14 RESOURCES used for this presentation and available on our website Resident Assessment Instrument RAI Manual Ch 3 Section H I M RAI Care Area Assessment CAA Urinary Incontinence Indwelling Catheter provides review guidance Quality Measure User Manual Centers for Disease Control CDC SLIDE 15 The last slide has our contact information and web address Please call or e mail us with any questions Thank You 6of5
6. sing Home Compare the federal public nursing home website e 5 STAR Rating the 11 included Quality Measure e Nursing Home Quality Care Collaborative NHQCC Composite Measure Score It is one of the 13 included quality measures e Reviewed during the Annual Survey process SLIDE 5 This is a SCREEN SHOT OF THE SPECIFICATIONS FOR Percent of Residents Who Have Had a Catheter Inserted Left in Their Bladder to briefly review Numerator all long stay target assessments indicating use of a Indwelling catheter Denominator all long stay residents with selected target assessment except EXCLUSIONS Exclusions from the Denominator 1 Target assessment is an admission assessment or a medicare PPS 5 day 2 Target assessment indicates that indwelling catheter status is SKIPPED or missing The Coding Instructions for Section H0100 Apliances appliance that was used at any time in the past 7 days BE SURE to Select none of the above To not check none of the above will trigger status missing 3 Target assessment indicates neurogenic bladder or neurogenic bladder status is SKIPPED missing 4 Target assessment indicates obstructive uropathy or obstructive uropathy status is SKIPPED missing Again is no answer is checked it will trigger missing or skipped 2of5 Cath script SLIDE 6 This is a Screen shot of MDS question H0100 The Resident can Triggers the QM when an Indwelling Catheter Including suprapubic catheter and n
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