Failure to Revise Care Plan for Incontinence Management
Penalty
Summary
The facility failed to revise the care plan for a resident with overactive bladder, urge incontinence, and congestive heart failure to reflect the resident's current status and needs. Despite multiple quarterly Bowel and Bladder Program Screeners and urology consults indicating the resident was a good candidate for scheduled toileting (timed voiding), the care plan continued to state the resident was unable to cognitively or physically participate in a retraining program due to impaired mobility. The resident was cognitively intact and required substantial assistance with toileting, but no trial of a toileting program was initiated, and the care plan was not updated to reflect recommendations from the urologist or the results of the screeners. Physician orders and specialist recommendations advised interventions such as timed toileting, limiting nighttime fluids, and avoiding irritants, but these were not incorporated into the care plan. The Director of Nursing Services confirmed that the care plan had not been updated to reflect the resident's candidacy for retraining or the recommendations from the urologist, and that the resident had not been interviewed regarding their wishes for a toileting program. Facility policy required ongoing revision of care plans as resident conditions changed, but this was not followed in this case.