QM ALERT: LOW RISK BOWEL & BLADDER

Loss of bowel or bladder control is not an ordinary part of the normal aging process, and treatable causes should be investigated. Incontinence can lead to poor quality of life, including personality changes for the resident, and is a risk factor for impaired skin condition, pressure ulcers, and urinary tract infections. Causes of incontinence may include medical conditions such as Diabetes, Dementia, or other chronic progressive diseases, medications, and medication changes, poor nutrition/hydration, limited mobility, and self care deficits.

Facilities should be proactive to determine the root cause, provide comprehensive assessment, search for appropriate treatments and adjust plans of care are those who will succeed in impacting their Quality Measure report in this area, as well as improving quality of life for their residents.

This Quality Measure reports the percentage of low risk residents who lose control of their bowel or bladder in a 7-day look-back period.

After drilling down and verifying the coding of the MDS is accurate, the facility should make sure appropriate interventions are in place to improve outcomes. To prevent incontinence in low-risk residents, protocols that embrace primary prevention strategies should be implemented. These protocols include assisting residents to maintain mobility and transfer abilities, thus reducing incidences of incontinence. Bladder control is a social skill developed during the first five years of life. Facilitating cognitive functioning by creating triggers (such as prompting the resident to void and helping the resident to sit on the toilet) may also help preserve continence.

If your facility has an observed percentage that is higher than state/national averages, or notice your percentages trending upwards it is important to review and develop a QAPI plan w/your interdisciplinary team.