Failure to Provide Timely Incontinence Care and Maintain Catheter Privacy
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary incontinence care to a dependent hospice resident and to maintain catheter privacy for another resident. During incontinence rounds, a surveyor observed a cognitively impaired hospice resident with dementia sitting in a brief that was saturated with brown-colored urine, which had seeped up the back of the incontinence brief. The resident had a documented wound on the buttocks, and the CNA present confirmed the brief was saturated. The CNA stated that the hospice aide had been providing care that morning but could not say when the aide had left. The resident’s MDS documented that the resident was always incontinent of bowel and bladder, and the care plan interventions included checking the resident every 2–4 hours and assisting with toileting as needed. Record review showed that CNA tasks for bowel/toileting care every 2–4 hours and as tolerated during waking hours and PRN reflected only one care entry at 6:22 AM on the day of observation. Interviews with nursing staff, including an LPN and the LPN/unit manager, confirmed that hospice residents were not to be excluded from incontinence rounds and should be checked every two hours. The hospice home health aide reported that she completed care for the resident at approximately 7:30 AM, left the resident clean and freshly changed, and gave report to the nurse. She further stated that on the prior two days, she had found the resident saturated to the point that urine had soaked through the brief, sheets, clothing, and onto the bed. Facility policy on ADL care required toileting and incontinence care to be provided with care and as needed, and CNA responsibilities included keeping incontinent residents clean and dry and checking residents who cannot call for help frequently. A separate deficiency was identified regarding catheter privacy for another resident with an indwelling urinary catheter due to neuromuscular bladder dysfunction, muscle weakness, and difficulty walking. On multiple observations, the resident’s catheter bag was hanging from the bed frame without a privacy bag and was visible from the hallway. The resident’s MDS documented an indwelling catheter, and the care plan included an intervention to maintain a privacy bag with catheter care. The resident, who was cognitively intact, stated they wanted a privacy bag and reported that when going to therapy, staff placed the catheter bag next to them with urine visible to others. The LPN/unit manager, CNA, and DON all acknowledged that a privacy bag should have been in place to maintain the resident’s dignity, consistent with the facility’s Quality of Life/Dignity policy requiring staff to promote, maintain, and protect resident privacy.
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