Failure to Implement Scheduled Toileting for Incontinent Resident
Penalty
Summary
The facility failed to implement appropriate interventions to restore or manage bladder and bowel continence for a resident with a history of overactive bladder, urge incontinence, congestive heart failure, and prior bladder cancer. Despite multiple quarterly Bowel and Bladder Program Screeners indicating the resident was a good candidate for retraining or scheduled toileting, and urology consults recommending timed toileting and other interventions, there was no evidence that a toileting program or bladder retraining was trialed. The resident was cognitively intact, required substantial assistance with toileting, and had functional limitations, but the care plan and clinical record did not reflect any attempt to initiate a toileting program as recommended by both the screeners and the urologist. The care plan interventions focused on perineal care, monitoring for infection, and use of disposable briefs, but did not address the recommendations for scheduled toileting or retraining. Physician orders for medications related to bowel and bladder management were present, but the lack of communication and follow-through on the results of the continence screeners and urology recommendations led to a failure in providing appropriate care aimed at restoring or improving continence. The Director of Nursing confirmed that the nursing staff did not inform the care team of the screener results, resulting in missed opportunities to trial a toileting program.