Inadequate Perineal Care and Improper Catheter Bag Positioning
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate incontinent and catheter care to residents with indwelling catheters, resulting in inadequate perineal cleansing and improper catheter bag positioning. One female resident with anoxic brain damage, neuromuscular bladder dysfunction, and severe cognitive impairment was always incontinent of bowel and bladder and had an indwelling Foley catheter ordered with catheter care every shift. During observed peri care after a bowel movement, the CNA cleansed only the external front perineal area without separating the resident’s legs or labia. When asked to demonstrate the care just provided, the CNA then separated the labia, at which time brown fecal matter was observed in the pubic hair and inner labial area, and subsequent cleansing produced wipes containing brown fecal matter. The CNA later acknowledged she should have opened the resident’s legs more to clean between the labial folds and that not doing so could place the resident at risk of infection. The same resident’s catheter bag was observed hanging on the side of the bed and touching the floor during the incontinent care. The resident’s care plan directed that the catheter bag and tubing be positioned below the level of the bladder and away from the entrance room door, and the facility’s Foley catheter policy instructed staff to secure drainage tubing to the bed frame and allow tubing to rest on the bed surface. The DON stated staff should place a basin under the catheter bag to prevent it from touching the floor and that staff should clean between the labia folds to prevent UTIs. Facility documents showed that the CNA had completed orientation and an incontinent care skills competency checklist indicating she had been evaluated as meeting competency in positioning the resident with legs apart and washing the perineal area from front to back, including thorough cleansing and drying, and the facility’s perineal care policy required staff to separate the labia and wash from front to back, including the inner labial area and rectal area. A male resident with hydronephrosis, dementia with moderate cognitive impairment, and impaired bowel and bladder evacuation used a Foley catheter and was care planned as incontinent of bowel and bladder. His care plan documented that he at times removed his privacy bag and leg strap, pulled on the Foley tubing, carried the bag in his lap or let it drop to the floor, and placed the Foley bag on the bed instead of hanging it on the bed frame. During observation, his catheter bag was seen lying on the floor by his bed on more than one occasion. A CNA stated staff tried to hang the catheter bag on the side of the bed but, due to the low bed position and fall mat, it was difficult to keep the bag off the floor, and that the resident frequently moved the bag himself and sometimes walked while holding it. An LVN acknowledged knowing the catheter bag touched the floor because of the low bed position and stated this could cause an infection, and also reported that when the resident was in his wheelchair he often tried to hook the bag on his belt and had to be redirected that it needed to be lower, while also stating she was not sure what could be done to prevent infection from the bag touching the floor.
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