Failure to Provide Bladder Retraining Program After Change in Resident Condition
Penalty
Summary
Facility staff failed to provide a toileting program or bowel and bladder retraining for a resident who had been admitted with an indwelling catheter and later had the catheter discontinued. The resident's initial bowel and bladder screening indicated they were a poor candidate for retraining due to sleepiness and forgetfulness. However, after the catheter was removed, the resident became more alert and mobile, and was observed to be continent on several occasions and able to walk to the bathroom independently. Despite these changes, staff did not repeat the screening or initiate a bladder retraining program as required by facility policy. The resident expressed interest in participating in a bladder retraining program, stating they could feel the urge to use the bathroom when awake. Interviews with the ADON and DON confirmed that the required reassessment was not completed after the resident's condition improved, and no individualized retraining program was provided. Facility policy required reassessment and care plan updates within 14 days of admission and quarterly, but this was not followed in the resident's case.