Information Bulletin 05-5
Urinary Incontinence and Catheters: Federal and State Requirements.
Revision of Appendix PP, State Operations Manual (SOP), Surveyor Guidance for Incontinence and Catheters: Implementation Date: November 7, 2005
[This bulletin replaces MDH Bulletin 01-12 Urinary Incontinence.]
The purpose of this information bulletin is to inform providers that Minnesota Department of Health surveyors and investigators effective November 7, 2005 will implement Survey Guidelines and Regulatory Changes related to Urinary Incontinence (UI) and Catheters (F315) Regulatory Text found in CMS Transmittal 8 and CMS Survey and Certification Letter 05-23.
MDH is consolidating duplicative and out of date information related to this clinical area into this information bulletin. Clinical information about urinary incontinence previously available in MDH Information 01-12 can be accessed in the revised federal guidelines.
Related Minnesota state laws/rules still in effect are included in this bulletin related to UI.
Background Federal Changes:
The Center for Medicare and Medicaid Services issued revised Long Term Care Surveyor Guidelines for Incontinence and Catheters and other regulatory text changes in June of 2005 in Transmittal 8. The CMS Survey and Certification Letter 05-23 explains in greater detail the background and context of these changes.
In summary: These changes are part of an ongoing CMS project to issue guidance relating to the expanded clinical interpretive guidelines, surveyor investigative protocols and specific severity guidance for determining the correct level of severity of outcome to residents from deficiencies issued at tag F 315, Urinary Incontinence and Catheters. These revised guidelines include examples of deficient practices. The CMS revision includes the combining of tags F315 and F316 into one tag i.e.F315. Tag F316 has been deleted. The regulatory texts for both tags are combined, followed by this revised guidance.
The content of the transmittals are also updated by CMS in the web version of the State Operations Manual (SOM) and may be accessed in Appendix PP of the SOM.
Excerpts from Current Minnesota Requirements
Adequate and Proper Nursing Care
For ease in better understanding the current requirements, presented below is the rule language currently in effect. Rule language that is not in effect based on current Minnesota law has not been included.
Minnesota Rule 4658.0520 Adequate and Proper Nursing Care states in part:
Subpart 1. Care in general. A resident must receive nursing care and treatment, personal and custodial care, and supervision based on individual needs and preferences as identified in the comprehensive resident assessment and plan of care as described in parts 4658.0400 and 4658.0405. A nursing home resident must be out of bed as much as possible unless there is a written order from the attending physician that the resident must remain in bed or the resident prefers to remain in bed.
Subpart 2. Criteria for determining adequate and proper care. The criteria for determining adequate and proper care include:
- Evidence of adequate care and kind and considerate treatment at all times. Privacy must be respected and safeguarded.
- Clean skin and freedom from offensive odors. A bathing plan must be part of each resident's plan of care. A resident whose condition requires that the resident remain in bed must be given a complete bath at least every other day and more often as indicated.
Minnesota (MN) Session Laws 2003:
Section 144A.04 is amended.
Notwithstanding Minnesota Rules, part 4658.0520, an incontinent resident must be checked according to a specific time interval written in the resident's care plan. The resident's attending physician must authorize in writing any interval longer than two hours unless the resident, if competent, or a family member or legally appointed conservator, guardian, or health care agent of a resident who is not competent, agrees in writing to waive physician involvement in determining this interval, and this waiver is documented in the resident's care plan.
This section is effective July 1, 2003.
Minnesota Rule 4658.0520 further states:
An incontinent resident must receive perineal care following each episode of incontinence. Clean linens or clothing must be provided promptly each time the bed or clothing is soiled. Perineal care includes the washing and drying of the perineal area. Pads or diapers must be used to keep the bed dry and for the resident's comfort. Special attention must be given to the skin to prevent irritation. Rubber, plastic, or other types of protectors must be kept clean, be completely covered, and not come in direct contact with the resident. Soiled linen and clothing must be removed immediately from resident areas to prevent odors.
Rehabilitation Nursing Care
Minnesota Rule 4658.0525 Rehabilitation Nursing Care states in part:
Subpart 5. Incontinence. A nursing home must have a continuous program of bowel and bladder management to reduce incontinence and the unnecessary use of catheters. Based on the comprehensive resident assessment, a nursing home must ensure that:
- A resident who enters a nursing home without an indwelling catheter is not catheterized unless the resident's clinical condition indicates that catheterization was necessary; and
- A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible.
- The American Medical Directors Association (AMDA)
- The Quality Improvement Organizations, Medicare Quality Improvement Community Initiatives
- CMS Sharing Innovations in Quality website
- Association for Professionals in Infection Control and Epidemiology (APIC)
- Centers for Disease Control
- Annals of LTC publications
- American Foundation for Urologic Disease, Inc.
- American Geriatrics Society
References of non-MDH sources or sites on the internet are provided as a service and do not constitute or imply endorsement of these organizations or their programs by MDH. MDH is not responsible for the content of pages found at these sites.
If you have any questions regarding this Information Bulletin, please contact in writing:
Minnesota Department of Health
Compliance Monitoring Division
Licensing and Certification Program
85 East Seventh Place, Suite 300
PO Box 64900
St. Paul, MN 55164-0900
Telephone: (651) 201-4101.