Failure to Provide Proper Incontinence Care and Documentation
Penalty
Summary
A deficiency was identified when a resident who was incontinent and dependent on staff for hygiene care was found to be wearing two incontinent briefs, with the inner brief saturated with dark yellow urine. The resident reported waiting for a CNA to return for hygiene care and stated that the use of two briefs was initiated by staff, not by personal request. The resident indicated that the practice was accepted due to infrequent changes and concern about soiling outside the brief. There was no documentation in the care plan or medical record indicating a preference or request for two briefs by the resident. The CNA assigned to the resident confirmed that she checked the resident by feeling the outside of the two briefs and believed the resident was dry if the briefs did not feel heavy. The CNA acknowledged that only one brief should be used unless specifically requested by the resident, but also stated that some residents have special requests. However, the care plan did not reflect any such request or preference for two briefs for this resident. The CNA also reported rounding on residents two to three times per shift to check for incontinence care needs. Facility policy required residents to be kept clean and dry, with incontinence care provided at least every two hours, and care plans to be updated as changes occurred. The Director of Nursing confirmed that more than one brief should not be used unless requested by the resident, and that such preferences should be documented in the care plan along with education on associated risks. The surveyor found no evidence of documentation or education regarding the use of two briefs for this resident, and the facility administration did not provide additional information when informed of the concern.