Failure to Implement Scheduled Toileting and Timely Incontinence Care
Penalty
Summary
The deficiency involves the facility’s failure to implement and provide timely incontinence care and scheduled toileting for a resident who was always incontinent of bowel and bladder. The resident had diagnoses including post-polio syndrome, Bell’s palsy, osteoarthritis, muscle weakness, and bilateral myopia, and was dependent on staff for activities of daily living. The most recent MDS documented intact cognition, frequent rejection of care, and a risk for pressure ulcer development. The nursing plan of care identified bladder and bowel incontinence related to generalized weakness, with interventions to assist with toileting needs, evaluate patterns of urination and incontinence, provide disposable incontinence products, and provide peri-care after each incontinent episode. However, there were no scheduled toileting times or documented frequency for incontinence checks in the medical record, despite a bowel and bladder assessment indicating the resident was a potential candidate for scheduled toileting. On the morning of the survey, the resident reported being incontinent of urine and stated the last incontinence check occurred at 4:30 A.M. The LPN acting as the resident’s CNA stated she assumed care at 5:00 A.M. and confirmed she had not checked the resident for incontinence, despite acknowledging the resident should be checked every two hours and had chronic excoriation to the buttocks. At 9:48 A.M., the RN and LPN went to provide incontinence care; the LPN verified she had not previously asked the resident if she needed to be checked. Upon removal of the incontinence brief, the resident was found to be incontinent of a moderate amount of urine, with bilateral buttocks showing excoriated tissue. The DON confirmed the resident frequently refused care, that no toileting schedule had been established as indicated by the bowel and bladder assessment, and that the resident should have been asked if she needed to be checked or changed that morning.
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