Failure to Provide Scheduled Toileting and Appropriate Catheter Care
Penalty
Summary
The facility failed to provide scheduled toileting and promote continence for a resident who was cognitively intact and able to request assistance. Despite physician orders for prompted toileting and a care plan indicating the resident was a candidate for a prompted bowel program, staff did not assist or encourage the resident to use the bathroom or a bedside commode. The resident reported long waits for assistance, lack of access to a bathroom or commode, and being placed in briefs instead of being helped to the toilet. Observations confirmed the absence of a bedside commode and that staff routinely performed 'check and change' care rather than scheduled toileting. Therapy staff indicated the resident was capable of using the bathroom with minimal assistance, but there was a lack of communication between therapy and nursing staff regarding the resident's toileting abilities and needs. The required clinical admission assessment to identify bowel and bladder needs was not completed upon readmission, and staff relied on previous assessments without updating the care plan based on current needs. Another resident with an indwelling catheter and a history of urinary retention and uropathy did not receive appropriate catheter care to prevent and treat urinary tract infections (UTIs). The resident was dependent on staff for toileting and hygiene and had a care plan that included assistance with incontinence care and application of moisture barrier cream. However, there was no documentation of urinalysis or monitoring of urinary symptoms prior to the resident being hospitalized for a UTI. The resident reported being left in soiled briefs and with a full catheter bag for extended periods, leading to her calling the police for assistance. Hospital records confirmed the presence of a UTI, and interviews with staff corroborated that the resident's catheter bag was sometimes left full and leaking, with staff failing to document or report abnormal urine appearance or odor as required by facility policy. Interviews with staff revealed inadequate communication, insufficient documentation, and a lack of adherence to facility policies regarding restorative nursing care and catheter care. Staff did not consistently monitor or report changes in residents' urinary status, and there was a failure to ensure timely and appropriate toileting and incontinence care. These deficiencies resulted in residents not receiving the necessary care and services to promote continence and prevent urinary tract infections.