Resident Sent to Appointments in Double Briefs Without Change of Clothing
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident’s right to dignity by sending him to multiple medical appointments in double briefs and without adequate provisions for incontinence care or a change of clothing. The resident was an adult male with neurogenic bladder, paraplegia, psychotic disorder, schizophrenia, and spina bifida, with a BIMS score of 15 indicating intact cognition. His MDS and care plan documented that he was always incontinent of bowel and bladder and had a goal to remain clean, dry, and free from odors, with interventions including assistance with applying briefs and keeping his skin clean and dry. On the day in question, staffing records showed specific LVN and CNA assignments on the resident’s hall, but no clear assignment of responsibility for preparing him for his appointments. During transport to two appointments, the transportation driver observed that the resident’s clothes were wet and later learned at the urology office that he was wearing two urine-soaked briefs. The physician’s office had to provide a clean pair of pants and a new brief because the resident had no change of clothes or toiletries with him. The resident reported that he remembered wearing double briefs, that he was incontinent and unable to toilet himself, and that he believed staff had forgotten to change him, resulting in his briefs becoming very full. He stated that he was embarrassed to sit in soiled clothing at the doctor’s office. Interviews with staff revealed that CNAs were responsible for dressing the resident, but none of the interviewed CNAs recalled preparing him that morning, and some stated that night shift often got residents ready for early or out-of-town appointments. The LVN recalled only pushing the resident to the side door for transport and stated that CNAs were responsible for dressing and that double briefing was against facility rules. The transportation driver, who was not a CNA, stated she did not bring extra clothes or supplies, did not realize the resident was double briefed until the second appointment, and did not notify management of the incident. The DON stated that the transportation driver was responsible for keeping vans stocked with briefs, linens, and clothing, that residents did not typically carry personal bags for appointments, and that double briefing was never acceptable. The facility’s Quality of Life policy and mission statement emphasized caring for residents in a manner that promotes dignity and respect, which was not followed in this incident.
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