LHCR / Home Health Newsletters

February 2008

IMPROVEMENT IN URINARY INCONTINENCE

Urinary Incontinence (M0520, M0530) identifies presence of urinary incontinence or condition that requires urinary catheterization of any type (intermittent or indwelling) and identifies the time of day incontinence occurs. 

The most important thing is ensuring your staff consistently understands the question and knows how to answer it correctly.  This can be a very embarrassing situation for many patients so carefully observe the patient’s surroundings for the odor of urine and the presence of sanitary pads, protective clothing or disposable pads.  A combination of assessment, observation and interview with the patient and/or caregiver will provide you with the most accurate determination.  Here are some tips to consider during your assessment:

• Incontinence may result from physiologic reasons, cognitive impairments or mobility problems.

• If incontinence occurs under any situation (coughing, sneezing, laughing, etc.) and at any time (occasionally, once in a while, etc.), the patient is incontinent.

• If patient has anuria or a urinary ostomy, mark no incontinence or catheter (Response 0 for M0520).

• A leaking urinary drainage appliance is not considered incontinence and patient requires a urinary catheter (Response 2 for M0520) should be marked.

We know the importance of interpreting the OASIS terminology by all staff members in the same way.  We also know this can be a challenge so we’ve listed some clarifications for your review.

• An ostomy (ileal conduit, urostomy, ureterostomy) is not the same as a urinary catheter (indwelling, intermittent, external, suprapubic).

• If the patient is incontinent only during the day, mark during the day and night (Response 2 for M0530).  There is no other choice so this is the best response.

We’ll leave you with one last thought.  Don’t just record what you observe and what you hear.  Ask yourself if anything could help them.  Some suggestions are:  

• Would a bladder re-training program or pelvic floor exercises be appropriate? 

• Has patient been educated on timed voiding?

• Does your patient have a bladder or vaginal infection?

• Has the physician considered drug therapy?

Proper and consistent assessment is important in managing your patient’s health status.  We can provide you with the tools to improve performance and increase efficiency while still providing patient centered care.  For additional intervention tools, click here to view RESOURCES and download LHCR developed brochures and posters that may be useful for in-servicing staff on the importance of consistent assessment.