Failure to Develop Comprehensive Care Plans for Incontinence and NPO Status
Penalty
Summary
A deficiency occurred when the facility failed to develop and implement comprehensive care plans for two residents with specific clinical needs. For one resident with Parkinson's disease, bipolar disorder, and major depressive disorder, the clinical record and nurse aide documentation showed frequent urinary incontinence and occasional bowel incontinence. Despite this, the care plan did not address the resident's incontinence, and no assessment for incontinence was found in the medical record. Interviews with nursing staff confirmed that an assessment and care plan should have been completed, and a toileting program should have been considered, but these actions were not taken. The resident reported being aware of the need to urinate or have a bowel movement but required staff assistance for toileting due to mobility limitations. The resident wore an adult incontinence brief at all times because of delays in receiving help from staff and indicated that a toileting program had not been offered. Facility policy required a thorough assessment and care planning for residents with incontinence, but this was not followed in this case. For another resident with severe dysphagia, gastrostomy status, and a history of pneumonitis due to aspiration, the care plan failed to specify the resident's NPO (nothing by mouth) status, despite physician orders and nutrition evaluations indicating tube feeding as the sole source of nutrition. The written nurse aide assignment also did not indicate the NPO status, and staff interviews revealed that nurse aides relied on these assignments for care information. Facility policy required clear communication and documentation of NPO status, but this was not reflected in the care plan or assignment sheets at the time of the survey.