Failure to Honor Resident's Toileting Preferences Due to Staffing Constraints
Penalty
Summary
A deficiency was identified when a cognitively intact resident, who was dependent on staff for toileting and transfers, was not consistently provided with assistance according to her preferences. The resident preferred to use a bedside commode for toileting, as documented in her care guide, but staff frequently offered a bedpan instead, particularly during nighttime and mealtimes. Staff interviews confirmed that the use of the commode was limited by staffing levels and time constraints, with staff indicating that using the mechanical lift for commode transfers was too time-consuming. The resident expressed dissatisfaction with being offered the bedpan, which she found uncomfortable, and reported that her requests to use the commode were sometimes denied unless there were enough staff available. Review of the resident's care plan indicated a goal for her to be clean, dry, and odor-free, with interventions to encourage her to verbalize toileting needs and keep her call light within reach. However, the care plan did not specifically document her preference for the commode. Progress notes and occupational therapy documentation further supported that the resident was encouraged to use the commode and was not appropriate for bedpan use. Despite this, staff practice did not consistently align with the resident's preferences, resulting in care that did not fully support her right to self-determination and choice in daily living activities.
Plan Of Correction
1. A care conference will be scheduled with the Interdisciplinary Team (IDT) and resident to identify preferences and discuss how the facility can best meet resident's needs. Care plan will then be updated to reflect the discussion. 2. All residents have the potential to be affected. 3. Existing "Interdisciplinary Long-Term Care Resident Review Protocol" was updated to include: Resident and/or resident representative interview should include a discussion about care preferences and will be completed by a member of the IDT. Standard care preference questions should include the following: toileting, sleep and wake preferences, meals, and other care preferences the resident would like to share. With this information, care plans will be updated at least quarterly with resident and/or representative input and subsequently implemented into how their care is provided. 4. Bi-weekly long-term care resident review meetings will include an audit of all residents due for quarterly review to ensure that interviews were completed and identified preferences were implemented into the care plan for at least the next 12 weeks. 5. The Executive Director is responsible for compliance.