Nursing Home Quality Improvement Initiative

Quality Measure Fact Sheet:
Percent of Chronic/Long Term Care Residents Who have/had
a Catheter Inserted and Left in their Bladder

Why residents may have an indwelling catheter despite receiving good care:
Residents who cannot control their bladder or cannot use a toilet may have a thin, soft tube inserted in the bladder; the tube is attached to a bag that collects urine. Catheters should not be used for convenience of the nursing home staff. They should be used only when medically necessary as their use increases the possibilities of urinary tract or blood infections, physical injury, local injury, bladder stones, or blood in the urine. Good catheter care should help reduce but not prevent possible complications.

Despite good care, there are situations when residents will have an indwelling catheter. Some residents cannot pass urine due to neurologic disease, and without a catheter would become medically ill. In residents who lose control of their bladder, a catheter may be appropriate (instead of having the resident wear a diaper) for those who have surgical wounds or pressure ulcers that cannot heal, or to monitor fluid balance in the acutely ill resident. Catheters are also used for the care of terminally ill or severely ill residents for whom bed and clothing changes are uncomfortable or disruptive.

What conditions exclude a resident from this measure: (Risk adjustment)
Residents who have been recently admitted to the facility are excluded from the measure.

Questions you can ask the facility if they are rated high in this measure: Under what conditions does the facility recommend insertion of a catheter? What does the facility do to prevent complications from using a catheter, such as urinary tract infections? How does the facility restrict use of indwelling catheters? How does the facility maintain and monitor use of catheter?