Per numerous research studies, Urinary Tract Infections have been among the most common infections in Nursing Homes for years. It has been thought to be over reported as well as under reported and is noted to be a significant cause for hospitalization and rehospitalization. As such, tracking the number of Urinary Tract Infections in the long-term care setting was made a quality measure back in 2010. This Quality Measure looks at the percent of residents with a Urinary Tract Infection (UTI). It is a long-stay measure, which impacts Care Compare and the Five-Star Quality Rating System. It measures the percentage of long-stay residents with a target assessment who have a urinary tract infection within the last 30 days.
Urinary Tract Infection is coded in I2300 and is only coded if all the following conditions are met:
- Resident has a UTI using evidence-based criteria
- Documented signs and symptoms of a UTI such as fever, burning, frequent urination, tenderness or pain in the flank, confusion, mental status, or pyuria;
- Significant laboratory findings; AND,
- Current medication or treatment of a UTI has occurred in the last 30 days; AND,
- Physician documented UTI diagnosis in the last30 days.
*Note it could be a physician, nurse practitioner, physician assistant, or clinical nurse specialist.
Evidence-based criteria includes the use of tools such as McGeer, HHSN, or Loeb. Here are a few tips:
1. Select the appropriate evidenced based criteria for your facility
2. Train nurses and clinicians who can document UTI diagnosis on how to use the selected criteria
3. Monitor compliance using the criteria
Further, ensure proper coding on the MDS as established in the RAI Manual and based on the above criteria.
The numerator for the measure is the number of long stay residents whose selected target assessment indicates a urinary tract infection in the last 30 days.
The denominator is all long-stay residents with a target assessment, 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).
- Urinary tract infection value is missing (I2300= [-]).
There are no covariates for risk adjustment for this measure.
State Surveyors use the Urinary Catheter or UTI Critical Element Pathway 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 issues related to UTI. Interventions should focus on areas such:
- Fluid maintenance (i.e., hydration)
- 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 with focus on areas such as:
- Activities of Daily Living, particularly hygiene, dressing, eating, showering
- Continence management (i.e., adaptive equipment, continence strategies)
As evidenced by the above, everyone from dietary to nursing to maintenance to therapy should be involved in aiding residents with improving and maintaining a resident’s overall health and quality of life.