A Standardized Quality Assessment System To Evaluate Incontinence Care in the Nursing Home

Authors

  • John F. Schnelle PhD,

    1. From the *Los Angeles Jewish Home for the Aging, UCLA Borun Center for Gerontological Research, Los Angeles, CaliforniaDepartment of Medicine, Division of Geriatrics, University of California at Los Angeles, Los Angeles, CaliforniaVeterans Administration Hospital, Sepulveda, California§School of Nursing, University of California at Los Angeles, Los Angeles, CaliforniaUrology Department, University Hospital, Novi Sad, Yugoslavia.
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  • Mary P. Cadogan RN, DrPH, GNP,

    1. From the *Los Angeles Jewish Home for the Aging, UCLA Borun Center for Gerontological Research, Los Angeles, CaliforniaDepartment of Medicine, Division of Geriatrics, University of California at Los Angeles, Los Angeles, CaliforniaVeterans Administration Hospital, Sepulveda, California§School of Nursing, University of California at Los Angeles, Los Angeles, CaliforniaUrology Department, University Hospital, Novi Sad, Yugoslavia.
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  • Dragan Grbic Dr,

    1. From the *Los Angeles Jewish Home for the Aging, UCLA Borun Center for Gerontological Research, Los Angeles, CaliforniaDepartment of Medicine, Division of Geriatrics, University of California at Los Angeles, Los Angeles, CaliforniaVeterans Administration Hospital, Sepulveda, California§School of Nursing, University of California at Los Angeles, Los Angeles, CaliforniaUrology Department, University Hospital, Novi Sad, Yugoslavia.
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  • Barbara M. Bates-jensen PhD, RN, CWOCN,

    1. From the *Los Angeles Jewish Home for the Aging, UCLA Borun Center for Gerontological Research, Los Angeles, CaliforniaDepartment of Medicine, Division of Geriatrics, University of California at Los Angeles, Los Angeles, CaliforniaVeterans Administration Hospital, Sepulveda, California§School of Nursing, University of California at Los Angeles, Los Angeles, CaliforniaUrology Department, University Hospital, Novi Sad, Yugoslavia.
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  • Dan Osterweil MD, CMD,

    1. From the *Los Angeles Jewish Home for the Aging, UCLA Borun Center for Gerontological Research, Los Angeles, CaliforniaDepartment of Medicine, Division of Geriatrics, University of California at Los Angeles, Los Angeles, CaliforniaVeterans Administration Hospital, Sepulveda, California§School of Nursing, University of California at Los Angeles, Los Angeles, CaliforniaUrology Department, University Hospital, Novi Sad, Yugoslavia.
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  • June Yoshii BS,

    1. From the *Los Angeles Jewish Home for the Aging, UCLA Borun Center for Gerontological Research, Los Angeles, CaliforniaDepartment of Medicine, Division of Geriatrics, University of California at Los Angeles, Los Angeles, CaliforniaVeterans Administration Hospital, Sepulveda, California§School of Nursing, University of California at Los Angeles, Los Angeles, CaliforniaUrology Department, University Hospital, Novi Sad, Yugoslavia.
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  • Sandra F. Simmons PhD

    1. From the *Los Angeles Jewish Home for the Aging, UCLA Borun Center for Gerontological Research, Los Angeles, CaliforniaDepartment of Medicine, Division of Geriatrics, University of California at Los Angeles, Los Angeles, CaliforniaVeterans Administration Hospital, Sepulveda, California§School of Nursing, University of California at Los Angeles, Los Angeles, CaliforniaUrology Department, University Hospital, Novi Sad, Yugoslavia.
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  • Research for this paper was supported by grants from the California HealthCare Foundation and the National Institutes on Aging: Claude D. Pepper Older Americans Independence Center AG10415. Prepared for the California HealthCare Foundation #99–5041 A. The views expressed in this paper are those of the authors and may not reflect those of the Foundation.

Address correspondence to John F. Schnelle, PhD, JHA/UCLA Borun Center, 7150 Tampa Avenue, Reseda, CA 91335. E-mail: jschnell@ucla.edu

Abstract

Objectives: To demonstrate the reliability and feasibility of a standardized protocol to assess and score urinary incontinence care in nursing homes.

Design: Descriptive.

Setting: Eighteen nursing homes (NHs).

Participants: Four hundred twenty-six incontinent residents.

Measurements: Resident interview data were used to score three quality indicators, and usable data were retrieved from 117 (27%) of 426 incontinent residents in 18 homes who were selected for interview based on evidence that they could accurately describe the care they received. Medical record data were used to score six quality indicators for a subset of 58 participants in five homes.

Results: Zero to 98% of the participants were scored as receiving care consistent with the intent of the indicator across the nine indicators. All NHs failed to provide chart documentation of an assessment to determine an incontinent resident's appropriateness for a scheduled toileting program (0% passed). The absence of an assessment to determine a resident's potential responsiveness to toileting assistance may explain why 103 incontinent residents who were documented on the Minimum Data Set as being on a scheduled toileting program reported that they received the same number of toileting assists per day (1.3) as the group of 114 incontinent residents who were not on a scheduled toileting program (1.0). The received toileting assistance frequencies reported by both groups were too low to maintain continence.

Conclusion: The standardized quality assessment system generated scores for nine incontinence quality indicators with good interrater reliability and provided explicit scoring rules that can facilitate replication. The focus of the indicators on care processes that are under the control of NH staff make the protocol useful for external survey and internal quality improvement purposes.

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