Failure to Provide Timely and Proper Incontinence Care and Peri-Care Technique
Penalty
Summary
The facility failed to provide appropriate incontinence care and maintain continence for a resident who was always incontinent of bladder and bowel, as documented on the quarterly MDS. The resident, an elderly female with severe cognitive impairment (BIMS score of 4) and multiple neurologic and medical conditions including aphasia, hemiplegia/hemiparesis, and severe sepsis, was care planned for bladder and bowel incontinence related to impaired mobility, with an intervention to check and change as required for incontinence. On observation, when staff removed the resident’s brief in the afternoon, there was a strong odor of urine and the brief was heavily soiled, despite CNA A stating that the last incontinence care provided had been at 10:00 a.m. and that care was usually provided every two hours. CNA A reported assisting residents in the dining room and then going on break without checking the resident for incontinence prior to the break and without knowing which CNA was to relieve her, while the RN on duty did not recall being informed of the break or knowing who was covering for CNA A. During the observed incontinence care, CNA A did not follow proper peri-care technique for a female resident. After the resident was repositioned to her right side, CNA A cleaned the perineal area from back to front using the same disposable washcloth, then continued to clean the buttocks in the same back-to-front manner with a new washcloth, contrary to the facility’s training form that directed washing the genital area from front to back. The resident’s skin was intact with no redness or rash at the time of observation. The DON stated that residents should be checked for incontinence every two hours and that failure to do so placed residents at risk for skin breakdown, urinary tract infections, and moisture-associated dermatitis, and also stated that CNAs are expected to notify other CNAs and the charge nurse when going on break and to ensure residents’ needs, including incontinence care, are met before leaving. The facility’s incontinence care policy emphasized keeping skin clean, dry, and free of irritation and odor, and preventing skin breakdown and infection.
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