ment Tool for Clinical Practice Guideline : Establish process and clinical outcomes measures before implementing the Urinary Incontinence (UI) in the Long Term Care Setting Clinical Practice Guideline (CPG). Identify measurable (quantitative) indicators as much as possible. Process measures evaluate how well a facility is implementing related processes of care, e.g., number of patients admitted that are assessed for urinary. Outcomes measures look at measurable changes in a patient s condition as a result of treatment or other interventions, e.g., number of patients with documented improvement in function. In the past, health care facilities mostly have relied on process measures. Recently, however, quality monitoring organizations have begun to demand outcomes measures. Both are important. Here are AMDA s suggested quantitative clinical process and clinical outcomes measures related to using the Urinary Incontinence CPG in a long-term care facility. These measures are based on the four recommended components of the AMDA urinary management process: Recognition, Assessment, Treatment, and Monitoring. Where noted, certain terms will require further definition by the facility. All clinical process and clinical outcomes measures should be defined using selected benchmarks, e.g., national norms or the facility s historical norms, if others are not available. General Process s Note: Documentation refers to whether a procedure/discussion was indicated/done or not indicated/not done. s (percentages) are obtained by multiplying each calculated fraction by 100 (for example, if 15 persons were assessed for urinary out of 45 who should have been assessed, the rate is 15/45 x 100 or.333 x 100 = 33.3%). All measures marked with an asterisk (*) are applicable for practitioners only.
Clinical Process s Recognition % of patients whose transfer summary is reviewed for a history of urinary on admission % of patients observed for current signs or symptoms of urinary on admission % of patients with onset and type of identified (to the extent possible) on admission *% of patients with diagnosed urinary whose symptoms are documented by the practitioner in the patient s record N = # of patients whose transfer summary is reviewed for a history of urinary on admission D = # of all new admissions N = # of patients observed for current signs or symptoms of urinary on admission D = # of all new admissions N = # of patients with onset and type of identified (to the extent possible) on admission D = # of patients identified with a history of urinary on admission N = # of patients with diagnosed urinary whose symptoms are documented by the practitioner in the patient s record D = # of all patients with diagnosed urinary
Assessment *% of patients assessed for modifiable causes of urinary so that interventions may be targeted to those factors *% of patients who have received a physical examination and workup as indicated for urinary *% of patients with urinary who have had their relevant information summarized N = # of patients assessed for modifiable causes of urinary so that interventions may be targeted to those factors D = # of all patients with risk factors for urinary N = # of patients who have received a physical examination and workup as indicated for urinary who have had their relevant information summarized
Treatment % of patients with urinary with individualized treatment goals and plans of care *% of patients with addressed transient causes of urinary *% of patients with addressed modifiable risk factors of urinary % of patients with urinary who are appropriate for a toileting program that have one *% of patients who have failed on nonpharmacologic interventions are evaluated for pharmacologic treatment % of patients with an indwelling catheter with documented medical justification with individualized treatment goals and plans of care N = # of patients with addressed transient causes of urinary N = # of patients with addressed modifiable risk factors of urinary who are appropriate for a toileting program that have one D = # of patients with urinary who are appropriate for a toileting program N = # of patients who have failed on nonpharmacologic interventions are evaluated for pharmacologic treatment D= # of patients who have failed on nonpharmacologic interventions N = # of patients with a indwelling catheter with documented medical justification D = # of patients with an indwelling catheter
Monitoring % of patients whose response to treatment for urinary is monitored and documented in the patient s medical record *% of patients with urinary whose response to the current treatment plan indicates a need for reassessment and receives such reassessment % of patients who are being monitored for side effects of medications prescribed for the treatment of urinary N = # of patients whose response to treatment for urinary is monitored and documented in the patient s medical record N= # of patients with urinary whose response to the current treatment plan indicates a need for reassessment and receives such reassessment D= # of patients with urinary whose response to current treatment indicates a need for reassessment N = # of patients who are being monitored for side effects of medication prescribed for the treatment of urinary D = # of patients receiving medication for urinary
Clinical Outcome s % of patients experiencing complications as a result of an indwelling catheter (such as pain, bleeding, blockage, urosepsis) % of patients with unnecessary indwelling catheters % of patients being treated for urinary that show resolution/ improvement of signs and symptoms of urinary % of patients utilizing appropriate continence products (such as comfortable, wick wetness away from skin, promote and maintain a healthy skin environment and are conductive to dignity) N = # of patients experiencing complications as a result of an indwelling catheter D= # of patients with an indwelling catheter N = # of patients with unnecessary indwelling catheters D = # of patients with an indwelling catheter N = # of patients being treated for urinary that show resolution/improvement of signs and symptoms of urinary D = # of patients being treated for urinary N = # of patients utilizing appropriate continence products D = # of patients utilizing continence products *% of patients with urinary who have had nonessential anticholinergic medications discontinued to reduce the overall anticholinergic load who have had nonessential anticholinergic medications discontinued to reduce the overall anticholinergic load receiving pharmacologic therapy