Improper Perineal Care Technique During Incontinent Care
Penalty
Summary
Surveyors identified a deficiency in the provision of incontinent care and catheter-related infection prevention for one resident. The resident had multiple diagnoses including convulsions, hypothyroidism, hyperlipidemia, dementia, hypertension, and obstructive and reflux uropathy, and was documented on the quarterly MDS as severely cognitively impaired with always incontinent bowel and bladder. The resident’s care plan included a problem of bladder incontinence with an intervention to monitor and document for signs and symptoms of UTI, such as pain, burning, blood-tinged urine, cloudiness, no output, deepening of urine color, increased pulse, increased temperature, urinary frequency, foul-smelling urine, fever, chills, altered mental status, change in behavior, and change in eating patterns. During an observation of incontinent care, a CNA was seen using a back-and-forth wiping motion instead of a front-to-back motion while cleaning the resident’s perineal area. The CNA later stated she should have wiped front to back instead of using a back-and-forth motion and performing multiple passes on the same area. The DON stated that staff should not use a back-and-forth motion during incontinent care and should perform a front-to-back pass with a wipe and change wipes before another pass to prevent fecal matter from entering the urinary tract. Review of the facility’s perineal care policy showed it directed staff to gently perform perineal care by wiping from the clean urethral area to the dirty rectal area. Despite this policy and documented annual training and proficiency checks, the observed care did not follow the required front-to-back technique.
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