Deficient Urinary and Bowel Care Services for Two Residents
Penalty
Summary
The facility failed to provide appropriate urinary and bowel care services for two residents. For one resident, who was admitted with a history of resistance to multiple antimicrobial drugs, urinary tract infection (UTI), acute kidney failure, and difficulty walking, the care plan indicated the resident was continent of bowel and bladder with a goal to keep the resident dry, clean, and comfortable. However, the Minimum Data Set (MDS) assessment reflected frequent incontinence and did not offer a bowel and bladder program. The resident reported awareness of the need to urinate and have bowel movements, rarely soiled herself, and expressed embarrassment after an incident of incontinence, stating that scheduled reminders and assistance would be helpful. Staff interviews confirmed that the care plan and MDS were inconsistent and that the resident should have been started on a bowel and bladder program to prevent UTIs and skin breakdown, as outlined in facility policy. For the second resident, who was admitted with diagnoses including a displaced avulsion fracture, difficulty walking, muscle weakness, and obstructive and reflux uropathy, the care plan required that the indwelling catheter bag and tubing be positioned below the level of the bladder. During observation, the resident's catheter tubing was found to have a large dependent loop containing yellow liquid with sediment, which had backflowed to the urine drainage port. A registered nurse confirmed that the tubing was improperly looped and that urine was not draining correctly, which could lead to infection. The DON stated that catheter tubing should always remain straight to prevent UTIs, especially for residents with a history of obstruction. Facility policies reviewed indicated the importance of providing appropriate treatment and services to minimize UTIs, restore bowel and bladder function, and prevent skin breakdown. The policies also specified that catheter collection bags should be kept below the level of the bladder to prevent backflow. The observed failures in care for both residents were inconsistent with these policies and resulted in deficiencies in providing necessary urinary and bowel care services.