Failure to Provide Bowel and Bladder Retraining Program for Incontinent Resident
Penalty
Summary
A deficiency was identified when a resident with diagnoses including schizophrenia, overactive bladder, and depression, who was alert, oriented, and had intact cognition, was not provided with a bowel and bladder retraining or toileting program despite being incontinent of bowel and bladder. The resident's Minimum Data Set (MDS) assessments consistently indicated frequent urinary incontinence and occasional bowel incontinence, yet there was no evidence of a structured retraining program in place. Interviews with staff, including the MDS Coordinator, CNA, LVN, and DON, confirmed that the resident was a candidate for such a program and would benefit from it, but the facility did not have an active program at the time. Record reviews showed that the resident's Bowel and Bladder Evaluations scored the resident as a possible candidate for retraining on two separate occasions. Despite this, there was no care plan addressing bowel and bladder retraining, no physician's order for the program, and no documentation of a formal retraining program being initiated. The facility's policy required assessment and initiation of retraining for appropriate candidates, but the policy was outdated and not being followed. The lack of a retraining program was further corroborated by staff interviews, where it was acknowledged that the resident should have been placed in such a program. The DON admitted the policy was outdated and that staff had not been in-serviced on the retraining program. The absence of a care plan, physician's order, and structured approach to bowel and bladder retraining for the resident constituted the deficiency.