Failure to Implement and Document Resident-Specific Bowel and Bladder Interventions
Penalty
Summary
The facility failed to ensure that evaluations for bowel and bladder retraining were used to select and implement resident-specific interventions to maintain or restore normal bowel and/or bladder function for two residents. For one resident admitted with pneumonia due to gram-negative bacteria, the Minimum Data Set (MDS) indicated the resident was always incontinent of both bladder and bowel, and no toileting program was attempted or in use. An evaluation determined the resident was a candidate for toileting and scheduled voiding, but the Director of Nursing (DON) confirmed that person-centered interventions were lacking, and it was unclear if rounding every two hours was appropriate or effective. The DON was also unable to determine if the resident's continence level changed during their stay. Another resident, admitted after digestive system surgery and with acute ischemia of the small intestine, reported frequent bowel incontinence and loose stools, requiring staff assistance for cleanup and expressing concern about attending appointments due to unpredictable bowel movements. The MDS showed frequent incontinence of both urine and bowel, with no toileting program attempted. An evaluation indicated candidacy for toileting and scheduled voiding, but the care plan only included general interventions such as assistance with toileting and pericare as needed. The Urinary Incontinence Tool was incomplete, missing information on medications, lab testing, cognitive patterns, referrals, and additional comments, despite the resident being on medications that could affect continence. Interviews with staff revealed that rounds were performed every two to four hours, and interventions to improve or maintain continence were limited to asking the resident about bowel movements. The DON acknowledged that resident-specific interventions were not documented, offered, or evaluated for effectiveness, and was unfamiliar with the use of the Urinary Incontinence Tool. Facility policy required individualized treatment and services for incontinence, but documentation and implementation of such interventions were lacking for both residents.