Urinary incontinence quality improvement in nursing homes: where have we been? Where are we going?

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.