Urinary Incontinence Quality Improvement in Nursing Homes: Where Have We Been? Where Are We Going?

Mary H. Palmer, PhD, RN, C, FAAN


Urol Nurs. 2008;28(6):439-444. 

In This Article

Abstract and Introduction


The Centers for Medicare and Medicaid Services (CMS) has made urinary incontinence (UI) a quality indicator as part of the Nursing Home Quality Initiative (NHQI). In addition, CMS issued revised guidance on UI and catheters (known as tag F315) for nursing homes regarding compliance in the evaluation and management of UI and catheters, and an investigative protocol for state nursing home surveyors to use during regulatory inspections. The prevalence of UI in nursing homes remains high despite many years of research and clinical efforts to cure or improve it. Nurses play a key role in assuring appropriate assessment of nursing home residents to prevent and treat UI. Changes at the organizational level and inpatient care are needed to make dignity of nursing home residents central to UI quality improvement efforts. This article reviews the epidemiology of UI, the evidence for behavioral interventions, and the types of quality improvement strategies used for UI in nursing homes.


Urinary incontinence (UI) in nursing homes has been the subject of clinical and research interest for nearly 30 years. It has been alternatively viewed as an in tractable problem requiring containment and as a problem worthy of rehabilitation efforts. Over the past few decades, nursing staff members and nursing home residents have been the subjects of many research studies investigating the effect of UI on psychosocial aspects of their lives. The effect of UI on nursing staff behavior in terms of work-related issues, such as turnover, has also been investigated. At the same time, behavioral interventions have been developed and tested in nursing homes. In addition, technological innovations have led to absorbent products that are designed to contain large quantities of urine and to protect the skin from the effects of incontinence.

UI is a quality indicator in the Centers for Medicare and Medicaid Services (CMS) Nursing Home Quality Initiative (NHQI) and thus is meant to serve as an indicator for consumers about the quality of care delivered by nursing homes (U.S. Department of Health and Human Services [DHHS] Centers for Medicare & Medicaid Services [CMS], 2006). Despite efforts of clinicians and researchers, however, over 50% of nursing home residents are incontinent of urine (DHHS CMS, 2005). This does not mean that nurses have failed in their efforts to prevent and treat UI, which is a complex condition influenced by intrinsic and extrinsic factors that are often beyond the control of the nursing staff. The real measure of success or failure is evidence of at-risk and incontinent residents receiving appropriate assessment and treatment for UI.

The purpose of this article is to review the epidemiology of UI in nursing homes, as well as discuss past and present quality improvement efforts for UI in nursing homes. In addition, recommendations for nursing interventions that address the incidence of incontinence and potentially reduce its prevalence among nursing home residents will be made.


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