The Quality Measure for new or worsened bowel or bladder incontinence is a long-stay measure. While this measure was frozen starting in April 2024, it began impacting Care Compare again in January 2025.
There are four conditions which meet the definition of new or worsened bowel or bladder incontinence.
The long stay measure looks at the percentage of residents with new or worsened bowel or bladder incontinence. The numerator for the measure is the number of long stay residents whose selected target and prior assessments indicate a new or worsened case of bowel or bladder incontinence has occurred when compared.
The denominator is the all long-stay residents with a target and prior assessment in the selected timeframe, except for those that meet the exclusion criteria. Exclusion criteria for this measure includes:
· Target Assessment is admission assessment (A0310A = 01) OR a PPS 5-day assessment (A0310B = 01).
· H0300 or H0400 are dashed on the prior or target assessment.
· Resident coded as comatose (B0100 = 1) or comatose status is dashed on the prior or target assessment.
· Resident has indwelling catheter (H0100A = 1) or indwelling catheter status is dashed on the prior or target assessment.
· Resident has an ostomy (H0100C = 1) or ostomy status is dashed on the prior or target assessment.
· No prior assessment is available for comparison.
Covariates for risk adjustment for this measure include:
· Severe cognitive impairment (C0500, C1000, C0700).
· Sitto Lying on prior assessment (GG0170B).
· Sitto Stand on prior assessment (GG0170D).
· Walk10 feet (GG0170I, GG0170Q) or Wheel 50 feet with 2 turns (GG0170R, GG0170Q) on prior assessment.
· Missing covariates 2 through 4 if no prior assessment.
State Surveyors use the Bladder or Bowel Incontinence Critical Element Pathway when reviewing facility performance. Aspects reviewed include comprehensive assessments focused on Section C, GG, and H of the MDS, Physician orders, pertinent diagnoses, and care planning. Staff assistance and interventions are observed across shifts, including PPE practices. 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 incontinence issues. Interventions should focus on areas such:
· Fluid maintenance
· Skin Integrity monitoring and maintenance (i.e., skin barriers)
· Use of absorbent products or protective clothing
· Environmental modifications (i.e., adequate lighting, call bell in reach, clear pathways, elevated toilet seat, grab bars, urinals, bedpans, or commodes)
· Scheduled toileting program
· Therapy services to address continence management (i.e., adaptive equipment, balance, continence strategies, strengthening, or transfers)
As evidenced by the above, everyone from dietary to nursing to maintenance to therapy should be involved in aiding residents with continence issues to improve a resident’s overall health and quality of life.