Improper Incontinence and Enteral Feeding Care Practices
Penalty
Summary
Certified Nursing Assistants (CNAs) were observed providing incontinence care to a resident with both short-term and long-term memory problems, as well as actual or potential skin integrity impairment due to incontinence and immobility. During care, a CNA was seen wiping from back to front, toward the resident's genitalia, contrary to facility policy and best practice, which require wiping from front to back to prevent infection. Interviews with the CNA, the Director of Nursing (DON), and the Administrator confirmed that the correct procedure was not followed, and that staff are expected to wipe away from the genitalia to reduce infection risk. Additionally, while the same resident was receiving enteral nutrition via a feeding pump, a CNA was observed lowering the head of the bed to a flat position to provide care, without pausing the feeding pump. This action was inconsistent with facility policy and standard practice, which require the feeding pump to be paused and the head of the bed to remain elevated to prevent aspiration. Interviews with staff, including the DON and an LPN, confirmed that the feeding pump should have been paused and the bed should not have been laid flat during enteral feeding. The resident's care plan indicated a need for tube feedings due to swallowing difficulties.