Deficient Bowel and Catheter Care for Two Residents
Penalty
Summary
A deficiency was identified regarding the care and services provided to two residents with bowel and bladder management needs. One resident with a history of intracranial injury, full fecal incontinence, and severe cognitive impairment did not have a documented bowel movement for more than three days, as evidenced by CNA task documentation. Despite facility protocols and staff interviews indicating that lack of bowel movement should trigger nursing intervention and physician notification, there was no evidence that the resident received any medication or intervention for constipation until after the resident was hospitalized for severe constipation. The clinical record showed no physician order for stool softeners or laxatives until after the hospital admission, and the resident was ultimately diagnosed with a large, retained stool mass requiring medical intervention. Another resident with an indwelling catheter for neurogenic bladder and severe cognitive impairment did not receive catheter care as ordered by the physician. The care plan and physician orders required catheter care and securing the catheter with an anchoring device every shift, as well as regular monitoring of the catheter tubing and bag. However, review of the CNA Bowel and Bladder Elimination Report revealed inconsistent and infrequent documentation of catheter care, with several days showing only a single check or no documentation at all. There was no evidence that the physician was notified about the missed catheter care, nor any documentation explaining the lapses. Staff interviews confirmed that both CNAs and nurses were responsible for monitoring and documenting bowel movements and catheter care, and that the facility's electronic medical record system was designed to alert staff to issues such as missed bowel movements. Despite these systems and protocols, the required care was not consistently provided or documented for the two residents, resulting in deficiencies related to the management of constipation and catheter care.