Failure to Implement and Evaluate Toileting Programs for Cognitively Intact Residents
Penalty
Summary
The facility failed to implement and evaluate toileting programs for two residents who were incontinent of bladder, despite both being cognitively intact and able to feel the urge to void. For one resident, records showed new onset bladder incontinence following a femur fracture and impaired mobility. Although the care plan included interventions such as establishing voiding patterns and changing briefs as needed, there was no evidence that a trial toileting program was attempted. The 72-hour toileting log was found to be inaccurate, and the DON confirmed that the resident was not evaluated for a toileting program. For the second resident, who had impaired mobility, prostate enlargement, and end stage renal disease, the care plan also aimed to keep the resident clean and dry with interventions like waking at night to void and regular brief changes. However, no rationale was provided for not attempting a toileting program, and the 72-hour toileting log was incomplete. Interviews revealed that the resident could feel the urge to void and had recently improved mobility, but was still not evaluated for a toileting plan. The DON confirmed the lack of a completed toileting log and the absence of a facility policy for toileting programs.