Improper Double Briefing by CNA Causes Physical and Psychosocial Harm
Penalty
Summary
A facility failed to ensure that a resident received continence care in accordance with professional standards, resulting in improper application of incontinence briefs. Specifically, a certified nursing assistant (CNA) from a staffing agency applied two incontinence briefs to a resident, with the inner brief folded and a hole cut in the center through which the resident's penis was pulled. This method caused constriction, swelling, and pain to the resident, who had a medical history of prostatic hyperplasia with lower urinary tract symptoms and obstructive and reflux uropathy. The improper application was discovered during morning care by another CNA, who found the resident in pain and with visible swelling and discoloration of the penis. The resident was subsequently assessed by a licensed nurse, who confirmed the improper placement of the briefs and noted that the opening in the inner brief was so tight it acted like a rubber band, causing further swelling and skin breakdown. The resident was sent to the emergency room, where he was diagnosed with paraphimosis, a condition where the foreskin becomes trapped behind the head of the penis, leading to swelling and pain. The resident also experienced psychosocial harm, including embarrassment and reluctance to discuss the incident. Interviews with facility staff and review of documentation revealed that the CNA responsible for the double briefing admitted to using this technique routinely with residents he considered "heavy wetters" and had done so in other facilities. The facility's investigation substantiated that the CNA's actions constituted neglect, as they deviated from accepted standards of care and facility policy, which explicitly prohibits double briefing due to the risk of skin breakdown and harm. The facility was unable to verify that the registry CNA had completed required competencies before working on the floor.