For nursing homes, it’s important to know the impact that specific quality measures can have on overall composite scores. For example, incontinence is the top quality measure driving composite scores up in Kentucky nursing homes, with 50 percent of residents being incontinent.

The national goal established by the Centers for Medicare & Medicaid Services (CMS) for nursing home composite scores is 6.00 or lower. A 50 percent incontinence rate can drive up that score. Focusing quality improvement efforts in this area may be a quick way for a facility to improve its composite score.

Incontinence has a number of negative effects on the resident, including:

• Interfering with activities;
• Embarrassing the resident;
• Increasing feelings of dependency;
• Increasing risk of long-term institutionalization;
• Increasing risk of skin breakdown/rashes;
• Increasing risk of urinary tract infection and
• Increasing risk of falls/injuries.

In addressing incontinence, consider factors such as

• mobility issues,
• change in environment,
• recent surgery and
• effect of medications.

Tactics and Interventions
It’s important to ask the resident and/or family about previous toileting habits, particularly before putting them on a scheduled toileting program. A personalized toilet schedule is best and a three-day voiding diary on admission (as well as quarterly assessments and readmissions) can help to determine if there is a pattern to the resident’s incontinence. These diaries can help formulate an effective toileting program for each resident and decrease resident incontinence.

Other interventions include

• involving therapy for bladder training and muscle development,
• reviewing medication and
• reviewing the resident’s medical history.

There will always be residents who are incontinent. Through communication and well-targeted interventions, change can happen, the rate of incontinence among residents can decrease and the overall composite score can improve.

Formed as a partnership between three leading healthcare consultancies, atom Alliance is working under contract to CMS throughout Alabama, Indiana, Kentucky, Mississippi, and Tennessee to improve quality and achieve better outcomes in health and healthcare and at lower costs. Learn more.

Mitzi Daffron, RN, MSM, CPHQ

Mitzi has a passion for healthcare quality. Since 1993, she has worked primarily in the Medicare Quality Improvement Organization (QIO) community helping healthcare professionals solve challenges and deliver measurable results. She has worked with organizations to identify opportunities for improvement through strategic planning activities and is a strong patient safety advocate, having attended the Agency for Healthcare Research and Quality’s (AHRQ’s) Patient Safety Improvement Corp. She believes that better healthcare quality and patient safety are within our grasp and is willing to go the extra mile to see these goals reached.