CMS Inpatient Prospective Payment Changes: The Role of the Community Hospital CWOCN in Preventing CAUTI and MASD

Beginning October 1, 2008, CMS implemented a new payment system to reward hospitals for quality care and avoid payment for unnecessary and preventable conditions.  A community hospital CWOCN participated in a task force to prevent catheter associated urinary tract infection (CAUTI) within the facility, and developed programs for managing incontinence and preventing moisture associated skin damage (MASD). 

Decreasing the utilization of indwelling catheters was one measure implemented to prevent CAUTI.  The CWOCN recognized that as a result, the number of patients experiencing urinary incontinence may increase, as well as the risk of MASD.  The CWOCN provided expertise in the following:

• Literature review and Policy/Procedure writing for indwelling catheter and bladder scanner use
• Toileting protocols and behavioral modification education for caregivers and patients
• Updated Moisture/Incontinence Algorithm to guide caregivers in appropriate moisture barrier product and absorbent pad use  
• Updated computerized care planning and documentation tools to include the new guidelines for catheter use and prevention of MASD 
• Pocket education cards for the staff outlining the types of MASD with photos 
• New containment products for use as alternatives to indwelling catheters, including a retracted penis pouch, female urinary pouch, and male external catheters
• A cost analysis on previous inpatients with MASD to determine costs of caring for the skin damage
• Staff education: Live in-services, laminated written education references

The purpose of this abstract is to compare the pre and post-test scores of 323 caregivers to evaluate knowledge base in prevention of CAUTI, MASD, and managing incontinence from before the staff education programs to after.  The pre-test was completed October 2008 with an average of 86.5% correct answers.  Education of staff will occur through January 2009, and a post-test will be completed in the spring of 2009 with the results presented at the conference.