Whodunnit? Let’s be honest!

Jan. 7, 2015 / By Cheryl Manchenton, RN

At the start of the New Year, I can’t help but reflect on how much patient care has changed in my 25+ years. Many things that were common practice back then were either not necessary or even sometimes harmful. An example would be Foley catheter placements. Foleys for “everyone” whether they needed them or not!

However, the advent of superbugs with increasing antibiotic resistance has also meant an increase in catheter-related UTIs. Organizations became focused on prevention, using different catheter materials thought to prevent colonization, and by evaluating the need for insertion and/or continued placement. It certainly didn’t hurt that catheter-associated UTIs (CAUTIs) were determined to be hospital-acquired preventable conditions that CMS would not reimburse, and were also factored into quality outcomes metrics by quality assessment programs or organizations.

Another item to remember when pondering CAUTIs is that currently, the only catheter associated urinary tract infections flagged as a quality concern are those associated with indwelling catheters or due to self-catheterization. This excludes UTIs due to ileostomy complications, ureteral stents, nephrostomy tubes and suprapubic catheters, which are assigned to a different complication code. Many times we miss the opportunity to clarify relationship in these scenarios.

Unfortunately there are competing issues surrounding CAUTIs. From a reimbursement perspective, confirmation of a catheter associated UTI may provide better reimbursement for the facility when it is present on admission (POA) and the reason for the admission. From a quality perspective, present on admission or not, providers are reluctant to identify catheters as the cause of UTIs as they may feel it assumes poor provider care. When the CAUTI is not POA, it is a quality “ding” against the institution. I have seen several CDI programs and quality departments only query for the relationship between the catheter and the UTI when it is beneficial, and avoid asking the question if it will result in a poor quality score. Unfortunately, this may have three net results:

1. Inappropriately lowering the true incidence of CAUTIs which may lull the organization into a false sense of confidence about the quality of the care. In other words, “If it ain’t broke, don’t fix it.”

2. Confusing the providers as to when they should and should not document the relationship between the catheter and the UTI.

3. Cast a light of “manipulating the data” on the organization.

Don’t get me wrong; I am totally in favor of obtaining clarification of POA status and clear documentation of complications as part of a strategy to improve quality scores. However, we must remember to do this with honesty and integrity.

Cheryl Manchenton is a senior inpatient consultant and project manager for 3M Health Information Systems.