Abstract: Ultrasound Technology and Bladder Dysfunction: Timely and Accurate Assessment Reduces Morbidity in Long-Term Care Facilities

Leslie Wooldridge, MSN, GNP, RN, CS. "Ultrasound Technology and Bladder Dysfunction: Timely and accurate assessment reduces morbidity in long-term care facilities." American Journal of Nursing Supplement (June 2000).

Objectives:
* Wooldridge reviews the benefits of bladder ultrasound and outlines a successful and cost-effective bladder-function assessment program for nursing home patients. She describes the problem of bladder dysfunction in the elderly, and the types of chronic urinary incontinence. Urinary retention, urinary tract infection, and complications that can result from bladder dysfunction are also discussed

Conclusions:
* "In the nursing home setting, 40% of all infections are in the urinary tract system (most often in the bladder). Of these infections, 80% are attributed to urinary tract catheterization and instrumentation, the most frequent cause of nosocomial infections."
* Urinary tract infection "can be very costly, both in terms of medication expenditures and staff time."
* Recently, the Health Care Financing Administration and the Department of Health and Human Services Agency for Health Care Policy and Research have developed requirements and protocols to direct the care of nursing home residents. "These protocols form the basis for the development of the nursing and interdisciplinary care plans. . . .In order to prevent functional urinary incontinence, nursing staff must now institute a voiding program, upon admission of each resident."
* Federal and AMDA guidelines recommend that PVR (post-void residual) should be measured as part of the bladder function assessment for each nursing home resident. "Historically, the gold standard for detecting urinary retention has been catheterization; however, this practice carries with it increased risk of infection, resulting in greater morbidity rates and expenditure. . . . The use of portable bladder ultrasound, which is a noninvasive, low-risk diagnostic tool, offers health care providers an alternative to catheterization when measuring bladder fullness and PVR."
* "The bladder scanner has been used to help identify bladder distention and explain agitation and frequent urination; it's also been used as an adjunct to bladder training."
* Bladder ultrasound is also useful as part of both intermittent catheterization programs and toileting programs, eliminating both unnecessary catheterization and unnecessary toileting, and allowing for accurate assessment of the patient's hydration status.
* "According to published reports, use of the bladder scanner leads to more efficient resident care because of the reduced frequency of bladder distention and catheterization and increased resident satisfaction with bladder management routines." The BladderScan^® has been found to decrease the amount of time nurses spend managing incontinent patients, is easy to use, prevents unnecessary catheterizations, offers an easy means of documenting the time, amount, and placement of urine in the bladder (this information can be printed after bladder volume is measured by portable ultrasound), and decreases the overall costs of caring for incontinent patients.
* "The struggle to create balance between quality of care and cost in the long-term care environment promises to continue as costs rise and Medicare and Medicaid reimbursements dwindle. Newer diagnostic techniques will better serve the elderly and will likely enhance the staff's ability to meet the demands of quality indicators and outcomes-based management. Bladder ultrasound can be a cost-effective method of facilitating ongoing assessment and treatment of urinary incontinence, urinary retention, and UTIs in long-term care facilities."

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