Failure to Implement and Document Individualized Bowel/Bladder Retraining Programs
Penalty
Summary
The deficiency involves the facility’s failure to implement its own policies and procedures for assessment and management of urinary and fecal incontinence for three cognitively intact residents who were always incontinent of bowel and bladder. Resident 2 was admitted with diagnoses including atherosclerosis of the aorta, lumbar vertebral fracture, low back pain, and mixed urinary incontinence. An MDS showed intact cognitive skills and a need for moderate to maximal assistance with toileting-related ADLs, with total dependence for toilet transfers, and documented that the resident was always incontinent of bowel and bladder. A bowel/bladder continence assessment identified the resident as a candidate for a Prompted Voiding Program, Habit Training/Scheduled Voiding, or Bladder Retraining, but did not specify which program would be used or any individualized interventions. The care plan for toileting and incontinence risk noted a goal to decrease incontinence episodes but likewise did not identify a specific retraining program or individualized approaches. Resident 3, originally admitted with diabetes mellitus and reduced mobility, also had an MDS indicating intact cognitive skills, maximal assistance needs for toileting hygiene and showering, dependence for lower body dressing and toilet transfer, and that the resident was always incontinent of bowel and bladder. A bowel/bladder assessment again identified candidacy for Prompted Voiding, Habit Training/Scheduled Voiding, or Bladder Retraining. However, the care plan, which documented that the resident was always incontinent of bowel with a goal to decrease bowel incontinence episodes, did not specify which bowel/bladder retraining program would be implemented or outline individualized interventions or approaches for carrying out such a program. Resident 4 was admitted with atherosclerosis of the aorta, a left femur fracture, and a left artificial hip joint. The MDS documented intact cognitive skills, maximal assistance needs for toileting hygiene and showering, dependence for lower body dressing and toilet transfer, and that the resident was always incontinent of bowel and bladder. The bowel/bladder assessment identified the resident as a candidate for Prompted Voiding, Habit Training/Scheduled Voiding, or Bladder Retraining, and the care plan included a goal to decrease incontinence episodes during a retraining period. Despite this, the care plan did not specify which retraining program would be used or any individualized interventions. Interviews with the MDS nurse and the ADON confirmed there was no documentation that any bowel/bladder retraining program had been implemented for these residents, nor any documentation that the residents had been offered, agreed to, or declined participation, despite facility policies requiring appropriate continence services, scheduled toileting or prompted voiding as indicated, and documentation of toileting trials and programs in the medical record.
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