Publications

A Safer, Healthier, and More Cost Effective Method to Manage Urinary Incontinence. Based Upon Medical Studies, We Believe That The TIMO May Also Reduce Urinary Tract Infections.

Urinary compromise is not only physically debilitating, but also robs a person of their dignity.  The TIMO offers the individual an alternative method for safe, convenient and controlled disposal to meet their urinary needs.  It provides an alternative to external and in some cases indwelling catheterization.  By eliminating urinary spillage it diminishes resultant ulcerative lesions occurring from urinary accidents. It also may diminish urinary tract infections by controlling urinary disposal.

BENEFITS OF TIMO

  • Allows patients to live with dignity secondary to improved urinary control.
  • Provides an alternative to external catheterization and in some cases indwelling catheterization.
  • Assists with urinary disposal.
  • Diminishes ulcerations resulting from complications of urinary incontinence.
  • May diminish urinary tract infections.

The following recent studies offer an understanding of how providing alternative treatment methods, such as the TIMO, can help to enhance the quality of life, health and dignity of those suffering from urinary incontinence.

Urinary incontinence in elderly nursing home patients.

Ouslander JG, Kane RL, Abrass IB.

Among elderly nursing home patients, urinary incontinence is a prevalent and costly condition. In seven nursing homes studied, 419 (50%) of the elderly patients were incontinence of urine. Most had been incontinent at admission (64%), had more than one incontinent episode per day or a catheter (72%), and had concomitant fecal incontinence (64%). The majority of incontinent patients had substantial cognitive impairment and limitations in mobility. The severity of these impairments was related to the extent of incontinence.Complications such as urinary tract infection and skin breakdown occurred in almost 45% and were more common in patients with catheters.Physicians recorded incontinence as a problem, or any efforts to evaluate it, in the nursing home records of less than 15% of these patients.

PMID: 7109138 [PubMed – indexed for MEDLINE]


Evaluation of urinary catheterization and urinary incontinence in a general nursing home population.

Ribeiro BJ, Smith SR

The medical records of 412 residents of three southeastern Massachusetts nursing homes were reviewed to examine the frequency and medical management of urinary incontinence and the indications for chronic urinary catheterization. The mean age of the patients was 84.1 years. In this study 9.7% of the patients were managed with a urinary catheter, while an indication for catheterization was recorded in the medical records of only 27.5% of these patients. Half of the noncatheterized nursing home patients were transiently or permanently incontinent of urine, but were not catheterized. Incontinent patients without catheters were more likely to require assistance in toileting (75.5 v 26.1%) or to have bacteriuria (60.1 v 26.1%) than continent patients. Despite the frequency of urinary incontinence, this problem was included in the medical problem list of less than 5% of the incontinent nursing home patients. The authors conclude that urinary incontinence is a frequent medical problem in the nursing home population, but it is rarely recorded and evaluated as a medical problem. Furthermore, indications for urinary catheterization frequently are also not recorded. An explanation for this practice was not determined, but possibilities include a lack of physician knowledge of the evaluation and management of incontinence and a nonaggressive approach to such patients, given their other medical problems.

PMID: 4008846 [PubMed – indexed for MEDLINE]


Management of urinary incontinence in Veterans Administration nursing homes.

Ouslander JG, Fowler E.

Nursing Home Care Units in Veterans Administration Medical Centers across the country were surveyed to determine methods of management of urinary incontinence (UI) in the nursing home (NH) setting. Information was obtained from 90 of the VA NHs on demographic aspects of the NH population, prevalence and severity of urinary and fecal incontinence, common problems encountered, and specific strategies and techniques. Written guidelines for bladder training and catheter care from many of the NHs were analyzed. The results of the survey reinforce the need for research designed to improve the care of the incontinent NH patient.

PMID: 3917465 [PubMed – indexed for MEDLINE]


Study finds catheter infections stoppable

BY PATRICIA ANSTETT
FREE PRESS MEDICAL WRITER

Urinary catheter infections account for 40% of all hospital infections, but U.S. hospitals do not have strategies in place to minimize them, according to a University of Michigan study to be released today.

Catheters are used on one in four patients, often after surgery, but as many as one third of the days in which patients have the devices are medically unnecessary, the study said. Infections from the devices, the most common type of infections acquired in hospitals, can be difficult to treat and can be life-threatening.

The issue takes on additional significance because in July Medicare stopped paying for care of urinary tract infections acquired while hospitalized. The average Medicare payment for a catheter-associated urinary tract infection was $40,347 in fiscal 2006.

Dr. Sanjay Saint, lead author and director of the patient safety enhancement program, advises hospitalized patients who have a catheter to ask their doctor every day: “Do I still need it?”

The study provides the first national examination of hospital prevention strategies at 119 Veterans Affairs and 600 nonfederal hospitals, conducted in 2005. It was published in the January issue of the journal Clinical Infectious Diseases, representing work by patient safety specialists at both U-M and the VA Ann Arbor Healthcare System.

One third of hospitals in the study did not track catheter use in their patients. Three-fourths had no system to know how long patients had one. Less than 10% used physician reminders, a proven strategy, to check catheter use daily, the study found…………


Knowledge and attitudes of nursing home staff and surveyors about the revised federal guidance for incontinence care.

DuBeau CE, Ouslander JG, Palmer MH.
Section of Geriatrics, University of Chicago, Chicago, IL 60637, USA. cdubeau@medicine.bsd.uchicago.edu

PURPOSE: We assessed nursing home staff and state nursing home surveyors regarding their knowledge and attitudes about urinary incontinence, its management, and the revised federal Tag F315 guidance for urinary incontinence. DESIGN AND METHODS: We conducted a questionnaire survey of a convenience sample of nursing home staff and state nursing home surveyors from a midwestern state attending two statewide workshops on the revised guidance.

RESULTS: Of 558 attendees, 500 (85%) responded, including 39% of the state’s directors of nursing and 57% of state nursing home surveyors. There were striking deficiencies in knowledge regarding urinary incontinence and catheter care, with significant discrepancies by type of respondent, particularly between state surveyors and nursing home staff. Staff cited documentation and staffing levels as the most frequent concerns about implementation. Open-ended responses reflected the divergence of concerns and antagonism among the stakeholders, and staff nurses’ feeling that F315 violated residents’ rights.

IMPLICATIONS: The revised Tag F315 guidance will be unlikely to improve the quality of urinary incontinence care in nursing homes because of significant knowledge and attitudinal discrepancies between nursing home staff and state surveyors, facility staff’s focus on documentation and staffing, and reliance on implementation strategies known to be ineffective. Federal, state, and other urinary incontinence guideline efforts should focus on managerial structures and methods to improve quality nursing home care. Research is needed to address how nursing home residents and families define and value “quality” urinary incontinence management and to incorporate these in quality-improvement strategies and measures.

PMID: 17766668 [PubMed – indexed for MEDLINE]

A Safer, Healthier, and More Cost Effective Method to Manage Urinary Incontinence. Based Upon Medical Studies, We Believe That The TIMO May Also Reduce Urinary Tract Infections.

Functional incontinence results from a person’s inability to safely and efficiently evacuate their urine. This is often the result of general debility which precludes their ability to either handle a urinal effectively or travel to the nearest toilet in a timely manner. The TIMO provides a safe and effective alternative for the disabled individual through controlled urinal placement and stabilization.

It has long been recognized that one of the hazards of closed urinary transfer secondary to catheterization is the urinary tract infection, resulting from bacteria invading the body through the urethra and transversing the various organelles of the urinary tract. Urinary tract infections can cause pain, tissue destruction, compromise a normal functioning kidney and resultant death. These risks can be diminished by reducing the bacteria present at the entrance to the urinary tract, by using a open elimination system.

See Results of the newest reported study on Hospital Acquired Urinary Tract Infections below:

Preventing Hospital-Acquired Urinary Tract Infection in the United States: A National Study – Abstract

Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.

Although urinary tract infection (UTI) is the most common hospital-acquired infection in the United States, to our knowledge, no national data exist describing what hospitals in the United States are doing to prevent this patient safety problem. We conducted a national study to examine the current practices used by hospitals to prevent hospital-acquired UTI.

We mailed written surveys to infection control coordinators at a national random sample of nonfederal US hospitals with an intensive care unit and >or=50 hospital beds (n=600) and to all Veterans Affairs (VA) hospitals (n=119). The survey asked about practices to prevent hospital-acquired UTI and other device-associated infections.

The response rate was 72%. Overall, 56% of hospitals did not have a system for monitoring which patients had urinary catheters placed, and 74% did not monitor catheter duration. Thirty percent of hospitals reported regularly using antimicrobial urinary catheters and portable bladder scanners; 14% used condom catheters, and 9% used catheter reminders. VA hospitals were more likely than non-VA hospitals to use portable bladder scanners (49% vs. 29%; P=.001), condom catheters (46% vs. 12%; P=.001), and suprapubic catheters (22% vs. 9%; P=.001); non-VA hospitals were more likely to use antimicrobial urinary catheters (30% vs. 14%; P=.001).

Despite the strong link between urinary catheters and subsequent UTI, we found no strategy that appeared to be widely used to prevent hospital-acquired UTI. The most commonly used practices–bladder ultrasound and antimicrobial catheters–were each used in fewer than one-third of hospitals, and urinary catheter reminders, which have proven benefits, were used in <10% of US hospitals.

Written by: Saint S, Kowalski CP, Kaufman SR, Hofer TP, Kauffman CA, Olmsted RN, Forman J, Banaszak-Holl J, Damschroder L, Krein SL.
Reference:
Clin Infect Dis. 2008 Jan 15;46(2):243-50
10.1086/524662
PubMed Abstract PMID: 18171256


Payment Change Puts Spotlight on Preventing Hospital Errors

By Carolyn M. Clancy, M.D. October 21, 2008

Patients don’t go into the hospital thinking they might get sicker because of the care they’ve received. But medical errors or lapses in care that harm patients happen. They occur despite the hard work many doctors, nurses, and hospitals have done to develop better ways of delivering care.

Medical errors take a big toll and can happen anywhere. One study found that mistakes cost insurers $9.3 billion in extra charges and caused 32,600 patient deaths each year. Medical errors happen in small hospitals and in big ones, including some of the best-known medical centers in the United States.

To address this problem, the Federal Government created a new rule. Starting October 1, it will no longer pay hospitals for the extra costs they charge when patients who are covered by Medicare (the Government health plan for people 65 years and older) develop some conditions as a result of the hospital’s care. Patients cannot be billed for the costs of these conditions, either.

This first-ever list of “hospital-acquired conditions” includes events that can be sharply reduced or even eliminated, according to research by my Agency, the Agency for Healthcare Research and Quality. They are:

  • Infection following certain kinds of surgery, including some orthopedic surgeries and surgery for obesity.
  • Blood clots or embolism that develop after knee and hip replacement procedures.
  • Mixing up blood types.
  • Air embolism (an air bubble in the blood stream).
  • Serious pressure ulcers (or bed sores caused by infrequent changes of position for bed-ridden patients).
  • Some falls and traumas.
  • Signs of poor blood glucose sugar control.
  • Urinary tract infections caused by catheters.

This new rule follows a trend that many private insurers are also putting into place. In 2007, for example, hospitals and insurers in Minnesota agreed that patients and health plans should not pay for any care described as a “never event” by a major health group. Two examples of these events are surgery performed on the wrong patient or on the wrong body part. Soon after, the national Blue Cross and Blue Shield group said that its 39 health plans will work to end payments for these serious patient events.

Because medical errors still occur, you may wonder if we know enough about how to prevent them from happening. I believe we do.

Let me give an example. About 1 million cases of urinary tract infections that are due to catheters (often used during and after surgery) occur each year in U.S. hospitals. These infections can cause longer hospital stays, more serious infections, and even death.  Research my Agency supported has shown that limiting the use of catheters to 3 days can sharply reduce the risk of these infections. Computer-based reminders about the 3-day timeframe are an effective way to help doctors and nurses follow this practice.

Another example is preventing a type of blood clot that forms in deep veins in the body, called deep vein thrombosis (DVT). A DVT can be deadly if it breaks off and blocks blood flow. Hospitals and clinicians can prevent many DVTs by taking specific steps.

A new guide from AHRQ helps hospitals and clinicians put procedures in place that can prevent dangerous blood clots. It explains how to start, evaluate, and maintain a prevention program and offers examples of successful ones that are already in place.

A new booklet for patients on how to prevent and treat blood clots is also available. In clear, easy-to-read language, the guide explains the symptoms of blood clots, offers tips on how to prevent them, and describes what to expect during treatment.

For many years, I have argued that following scientifically tested procedures can reduce or even eliminate many medical errors or lapses in care. It’s time that we put our knowledge into our day-to-day care for patients.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Carolyn Clancy, M.D.
Director
Agency for Healthcare Research and Quality (AHRQ)
U. S. Department of Health and Human Services


The Prevention of Hospital-Acquired Urinary Tract Infection

By Lindsay E. Nicolle

Lindsay E. Nicolle; The Prevention of Hospital-Acquired Urinary Tract Infection. Clin Infect Dis 2008; 46 (2): 251-253. doi: 10.1086/524663