Failure to Implement Toileting Program for Continent/Incontinent Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate treatment and services to restore or maintain bladder continence for a resident who was frequently incontinent and able to make her own decisions. The resident, admitted with respiratory failure with hypoxia, muscle weakness, and a tracheostomy, had care plans noting diuretic therapy for CHF with increased fall risk and occasional bladder incontinence related to COPD, respiratory failure, impaired mobility, and obesity. Her care plan interventions included use of a brief per her request, maintaining an unobstructed path to the bathroom, and checking her when incontinent "as required." A Bowel and Bladder Evaluation documented that she was an unlikely candidate for bowel and bladder retraining, and the MDS later documented that she did not have a toileting program and was frequently incontinent with bladder. The resident reported that it could take a while for staff to respond when she called for assistance, and that she attempted to take herself to the bathroom, lost her footing, fell, and soiled herself. A Change in Condition Evaluation documented that she was found on the floor after attempting to go to the bathroom unassisted, with pain in her lower back and right wrist, and that she stated she lost her balance and landed on her backside. A Fall Risk Evaluation identified balance problems while walking, decreased muscular coordination, and the need for assistive devices. The DON acknowledged that the resident fell when she went to the bathroom by herself and stated that the resident should be re-evaluated for a toileting program, as she had been in the facility a long time, could ambulate, and could be a candidate for a bowel and bladder toileting program. The facility’s own toileting program policy required bowel and bladder retraining for residents with potential to benefit and directed that toileting programs be addressed on the care plan and reassessed at least quarterly and as needed.
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