Nursing Home Quality Improvement Initiative
Quality Measure Fact Sheet:
Percent of Chronic/Long Term Care Residents Who Lose Control
of their Bowels or Bladder
What this means:
This measure reflects the percent of low-risk chronic-care residents who often lose control of their bowels or bladder. Low-risk residents include those who do not have severe dementia (loss of intellect including impaired memory and judgment) or loss of ability to perform all the activities of daily living (ADLs, which include eating, dressing and toileting).
Why residents may lose control of bowels or bladder despite receiving good care:
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 feelings of shame and embarrassment for the resident, and is a risk factor for rashes, pressure ulcers, and urinary tract infections. Causes of incontinence may include the following: (1) changes in medication (2) physical problems such as constipation, muscle weakness or bladder infection (3) medical conditions such as diabetes, depression, dementia, and neurological disease (4) limited ability to walk or move around (5) inadequate diet and fluid intake, and (6) restraints.
The incontinence may be improved or resolved by the following: placing a urinal or bedside commode in resident's room, helping resident get to the toilet, scheduled toileting, and decreasing the intake of caffeine. Despite the best medical and nursing interventions some residents, such as those with advanced dementia and other neurologic diseases, will lose control of bowel and bladder. These residents should be kept as clean and dry as possible.
Residents who need a catheter in their bladder will also be included in this measure as the indwelling catheter quality measure and the loss of bowel or bladder control measure are paired measures. Even with good nursing care, some residents will be counted in this measure due to physical problems and medical conditions.
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:
- How does the facility determine the cause of loss of bowel or bladder control?
- How many residents are restrained, and what's the procedure for their use?
- How often does staff help mobility impaired residents use the bathroom?
- How does the facility help the resident restore bowel or bladder control?
- How does the facility avoid complications such as pressure ulcers in these residents?
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