Insert catheters only for appropriate indications. â¢. Leave catheters in place only as long as needed. â¢. Only prope
Improving the Quality Measures: Percent of Residents with a Urinary Tract Infection (Long Stay)
Measure Description The measure reports the percentage of long stay residents who have a urinary tract infection
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Numerator Long-stay residents with a selected target assessment that indicates urinary tract infection within the last 30 days (I2300 is checked).
x
2
Denominator All long-stay residents with a selected target assessment, except those with exclusions.
3
Exclusions 1. Target assessment is an admission assessment (A0310A = [01]) or a PPS 5-day assessment (A0310B = [01]). 01
01
4
Exclusions 2. Urinary tract infection value is missing (I2300 = [-]).
-
5
How to Make Improvements Define Urinary Tract Infection (UTI) properly Use McGeer or Loeb criteria http://www.annalsoflongtermcare.com/news/ags-2014antibiotic-prescribing-urinary-tract-infection-catheter
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How to Make Improvements • • •
Criteria for antibiotic use includes symptoms of fever, new pain, new changes in condition, etc. See criteria definitions Foul-smelling, cloudy, and/or dark urine are not considered signs of an infection
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How to Make Improvements Prevent catheter associated UTIs Refer to CDC CAUTI Toolkit: http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf • • • • • • •
Insert catheters only for appropriate indications Leave catheters in place only as long as needed Only properly trained persons insert and maintain catheters Insert catheters using aseptic technique and sterile equipment Maintain a closed drainage system Maintain unobstructed urine flow Hand hygiene and standard (or appropriate isolation)precautions
8
How to Make Improvements Prevent non-catheter associated urinary tract infections: • Follow-evidence-based guidelines to obtain a UA/UC • Avoid indwelling catheter use unless appropriately indicated
9
How to Make Improvements • Educate staff and assure consistency on the criteria for UTIs • Provide training on pericare and catheter care • Encourage hydration • Develop protocols to notify MD with change in condition • Review medications
10
How to Make Improvements Analyze your findings for each resident with a UTI and document: • A description of the problem • The causes and contributing factors • The risk factors related to the UTI • Develop and implement an individualized plan of care based on the analysis • Refer to urologist as needed
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The Change Package: Strategies of High-Performing Nursing Homes Provide exceptional compassionate clinical care that treats the whole person by striving to prevent problems
Download the Change Package: https://www.lsqin.org/wpcontent/uploads/2015/03/NH-ChangePackage032615-Final-508.pdf
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Resources •
•
MDS 3.0 RAI Manual: https://www.cms.gov/Medicare/Quality-InitiativesPatient-AssessmentInstruments/NursingHomeQualityInits/MDS30RAI Manual.html MDS 3.0 QM User’s Manual: https://www.cms.gov/Medicare/Quality-InitiativesPatient-AssessmentInstruments/NursingHomeQualityInits/NHQIQualit yMeasures.html
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Contact the Lake Superior Quality Innovation Network Michigan: MPRO Kathleen Lavich 248-465-7399
[email protected]
Minnesota: Stratis Health Kristi Wergin 952-853-8561
[email protected]
Wisconsin: MetaStar Liz Dominguez 608-441-8266
[email protected]
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This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MI/MN/WI-C2-16-16 012116
