Overview of F690
F690 indicates that an indwelling catheter should not be inserted unless clinically indicated and removal should occur as soon as possible. Providers and nursing staff should assess risks to avoid complications, such as CAUTI (Catheter Associated Urinary Tract Infection), sepsis and others, related to ongoing use of the catheter. Additionally, a resident should receive appropriate treatment and services to prevent catheter-related complications.
IDT comprehensive assessment and admission evaluation should address risk factors for developing urinary incontinence or use of an indwelling catheter, evaluation of the resident’s medical history and physical exam, along with IDT review. Furthermore, reversible (i.e., medications) and irreversible causes (i.e, bladder tumor) of incontinence should be modified and/or considered along with evaluation of the need for continual use or plan for removal.
Current Professional Standards of Practice
- Documentation should include notes related to involvement of the resident/representative with communication of the risks and benefits related to catheter use, goal of removal of the catheter when clinically indicated, and the right to refuse the catheter
- Timely and appropriate assessments related to the indication for use of an indwelling catheter
- Identification and documentation of clinical indications for the use of a catheter as well as criteria for the discontinuance
- Insertion, ongoing care, and catheter removal protocols
- Response of the resident during the use of the catheter
- Ongoing monitoring for changes in condition related to possible CAUTI’s coupled with recognizing, reporting, and addressing such changes
- Identify specific clinical indications for the use of an indwelling catheter
- Assess whether other treatments and services would appropriately address those conditions (i.e., intermittent catheterization versus indwelling catheter)
- Assess whether residents are at risk for other possible complications resulting from the continuing use of the catheter, such as obstruction, urethral erosion, bladder spasms, hematuria, and leakage around the catheter.
The plan of care should contain the following specifics:
- Guidance of the provision of services and treatment for an indwelling catheter, or current or recurring UTI or CAUTI
- Interventions to prevent or address complications of the use of an indwelling catheter, such as UTIs, skin irritation/excoriation, leakage around the catheter, catheter-related injury/pain, encrustation, excessive urethral tension, accidental removal, or obstruction of urine outflow
- Interventions to maintain the resident and the catheter clean of feces to minimize bacterial migration into the urethra and bladder [e.g., cleaning fecal material away from rather than towards the urinary meatus] and keeping the drainage bag below the level of the bladder)
- Potential psychosocial issues related to urinary catheter use
- Centers for Disease Control and Prevention. 2015, November 5. Catheter-Associated Urinary Tract Infections (CAUTI). https://www.cdc.gov/infectioncontrol/guidelines/CAUTI/index.html
- Centers for Medicare & Medicaid Services Manual System. 2017, November 22. Pub. 100-07. State Operations Provider Certification. Transmittal 173. Revisions to State Operation Manual (SOM), Appendix PP Guidance to Surveyors for Long Term Care Facilities. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R173SOMA.pdf
Make plans to join Proactive for the webinar session Standards of Care for Incontinence, UTI and Catheters on December 15 or December 21, 2021.