incontinence - MDS vs. MMQ definitions

[glm777, BSN, RN]

We have a resident who has full bladder control, is aware of the urge to void, gets his urinal and uses it appropriately. However, when he removes it, he often spills a bit onto his chair and skin. Our MMQ nurse is saying that we have to code him as "incontinent" in section H because his skin gets wet from the spilled urine. I'm not sure I agree with this. Bladder continence is explained in the manual as the resident's ablitly to control urine. He has full control - he just has some technical difficulty managing his full urinal. What dp you all think?

[Talino]

your mmq nurse's assumption is based on these excerpts from the rai...

"determination of whether or not to code incontinence is not a matter of volume. it is a matter of skin wetness and irritation, and the associated risk for skin breakdown." last paragraph p3-119

"if the resident's skin gets wet with urine, or if whatever is next to the skin (i.e., pad, brief, underwear) gets wet, it should be counted as an episode of incontinence - even if it's just a small volume of urine, for example, due to stress incontinence. " 1st paragraph, p3-120

the analogy of having "full control" will be discounted by this excerpt...

"code for the resident's actual bladder and bowel continence pattern - i.e., the frequency with which the resident is wet and dry during the 14-day assessment period. do not record the level of control that the resident might have achieved under optimal circumstances." p3-121

however, all these excerpts refer to "control" during the time of the actual act of voiding. nowhere is it specifically mentioned whether to still capture "control" when the voiding process is already concluded, as in your case, spilling urine in a body part while putting the urinal away.

hence, it is opened to interpretation. based on a limited resource, the question is, "how long does the skin remain wet? if the area is dried within the next minute, is there still the risk of skin breakdown?

relying on the excerpts above, this is even a likely "incontinent" scenario ---

"an independent elderly female who has full bladder control but fails to dry herself after each voiding. her underwear is always slightly wet." is she incontinent?

when still in doubt, ask the state rai coordinator.

a spill-proof urinal would steer clear of a debate...

[woodstock571]

Has anyone in Mass questioned the RAI for clarification on this?