Failure to Develop and Implement Individualized Bowel and Bladder Retraining Care Plans
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement comprehensive, person-centered care plans for bowel and bladder (B&B) retraining for three residents who were assessed as candidates for such programs. For Resident 2, the admission record showed diagnoses including atherosclerosis of the aorta, lumbar vertebral fracture, low back pain, and mixed incontinence. The MDS documented intact cognition, a need for moderate to maximal assistance with toileting-related ADLs, and that the resident was always incontinent of bowel and bladder. A B&B continence assessment identified the resident as a candidate for Prompted Voiding, Habit Training/Scheduled Voiding, or Bladder Retraining. However, the care plan on toileting and incontinence, while noting risk for incontinence-associated dermatitis and a goal to decrease incontinence episodes, did not specify which B&B retraining program would be used or include individualized approaches or interventions describing how the program would be carried out. Resident 3’s admission and assessment information showed diagnoses including diabetes mellitus and reduced mobility, intact cognitive skills for daily decision making, and a need for maximal assistance or dependence for toileting hygiene, showering, lower body dressing, and toilet transfers. The MDS indicated the resident was always incontinent of both bladder and bowel, and the B&B assessment identified the resident as a candidate for Prompted Voiding, Habit Training/Scheduled Voiding, or Bladder Retraining. The care plan reports, initiated and later revised, documented that the resident was incontinent of bowel and bladder and set goals to decrease urinary and bowel incontinence episodes. Despite this, the care plans did not identify the specific type of B&B retraining program to be implemented and did not include individualized approaches or interventions outlining how the retraining program would be implemented. Resident 4’s records showed admission with diagnoses including atherosclerosis of the aorta, left femur fracture, and presence of a left artificial hip joint. The MDS documented intact cognition, a need for maximal assistance with toileting hygiene and showering, dependence for lower body dressing and toilet transfers, and that the resident was always incontinent of bowel and bladder. A B&B assessment again identified candidacy for Prompted Voiding, Habit Training/Scheduled Voiding, or Bladder Retraining. The care plan, which noted bowel and bladder incontinence and a goal to decrease incontinence episodes during the retraining period, did not specify which B&B retraining program would be used and did not include specific, individualized approaches or interventions. During interviews and record reviews, the MDS nurse and the ADON acknowledged that individualized, person-centered care plans addressing B&B retraining programs, including the type of program and specific interventions, had not been developed and implemented for these three residents, despite facility policy requiring comprehensive, person-centered care plans based on ongoing assessments.
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