H0200B. Urinary toileting program: response, Step-by-Step

Step-by-Step Coding Guide for Item Set: H0200B. Urinary Toileting Program: Response

1. Review of Medical Records

   • Begin by conducting a thorough review of the resident's medical records with a focus on notes related to a urinary toileting program. Pay special attention to nursing notes, physical therapy assessments, and any documented feedback from the resident or care staff about the resident's response to the toileting program. Look for progress notes that detail changes in urinary incontinence frequency or severity since the initiation of the program.

2. Understanding Definitions

   • Urinary Toileting Program: A care plan implemented to manage urinary incontinence or retention, which may include strategies like scheduled toileting, prompted voiding, or bladder training.
   • Response: The resident's outcome or change in urinary incontinence status as a result of participating in the toileting program.

3. Coding Instructions

   • Code 0: No improvement - if there’s no change in the frequency of incontinence episodes after the toileting program.
   • Code 1: Decreased wetness - if there’s a noticeable reduction in the frequency of incontinence episodes or the severity of wetness.
   • Code 2: Completely dry - if the resident achieves complete continence during the day and night.
   • Evaluate the resident's response based on documented evidence and direct observations or reports from care staff.

4. Coding Tips

   • To accurately code the resident's response, compare documentation of incontinence episodes before and after the toileting program was implemented.
   • Engage with care staff and the resident (if possible) for anecdotal evidence or self-reported improvements that might not be fully documented.

5. Documentation

   • In the MDS and the resident's care plan, document the selected code that reflects the resident's response to the toileting program. Include detailed notes on observed changes, staff and resident feedback, and any adjustments made to the program in response to the resident's progress or lack thereof.

6. Common Errors to Avoid

   • Failing to consider all sources of information (e.g., staff observations, resident self-reports) when evaluating the resident's response.
   • Not accurately tracking the frequency and severity of incontinence episodes before and after the initiation of the toileting program, leading to incorrect coding.

7. Practical Application

   • Example: Mr. Gonzalez, who was experiencing frequent urinary incontinence episodes, was placed on a prompted voiding program with toileting scheduled every 2 hours. After two weeks, nursing notes and feedback from Mr. Gonzalez indicate a significant reduction in daytime incontinence episodes, though occasional nighttime episodes persist. Based on this improvement, Mr. Gonzalez would be coded as "1" for Decreased wetness in H0200B. The care plan is updated to reflect these observations and to introduce strategies aimed at reducing nighttime incontinence.

The Step-by-Step Coding Guide for item H0200B in MDS 3.0 Section H is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.