Failure to Implement Individualized Toileting Programs
Penalty
Summary
The facility failed to develop and implement individualized measures for the toileting needs of two residents, leading to deficiencies in bowel and bladder management. Resident 27, who was readmitted with diagnoses including sepsis, COPD, and morbid obesity, was noted to be always incontinent of urine and bowel. Despite having a history of UTIs and being unable to walk to the bathroom, the facility did not complete a 72-hour bladder and bowel tracking form as required by their policy. This omission resulted in the absence of a scheduled toileting program or an individualized incontinence management schedule in the resident's care plan. Resident 74, admitted with esophageal cancer, metabolic encephalopathy, and protein calorie malnutrition, was also affected by the facility's failure to assess continence status. Although the resident was alert, oriented, and able to stand and pivot with assistance, the bowel continence section of their admission observation was incomplete. The admission MDS indicated occasional urinary incontinence and frequent bowel incontinence, yet no trial toileting program was attempted, and no individualized toileting or incontinence management program was developed. Interviews with the Assistant Director of Nursing confirmed that the facility did not assess the continence status of Residents 27 and 74 upon admission, nor did they complete the required 72-hour bladder and bowel tracker. Consequently, the facility failed to develop comprehensive care plans that reflected the residents' toileting needs, compromising their highest practicable level of independence and dignity.
Plan Of Correction
1. Resident 27 and 74 will have a new 72 hour bowel and bladder diary initiated, and based on the results of the assessment, an individualized plan will be implemented if indicated. 2. To identify residents with the potential to be affected, DON/designee will audit current residents to ensure a 72 hour bowel and bladder diary was completed as per policy. 3. To prevent from re-occurring, DON/designee will educate nursing staff on the continence management program. 4. To monitor and maintain, DON/designee will audit new admissions weekly x 4 weeks for evaluation of bladder function and appropriate program, then monthly for 2 months. All findings will be taken to the QAPI committee.