Improper Use of Double Briefing for Incontinent Residents
Penalty
Summary
The facility failed to ensure residents who were incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and restore continence to the extent possible, and failed to ensure CNAs did not place two briefs on residents. One resident admitted with diagnoses including lymphedema, chronic pain, anxiety, depression, diabetes mellitus, and dementia had an admission MDS showing intact cognition (BIMS 15), was dependent on staff for toileting, and was care planned to be checked and encouraged to use a commode and have briefs changed every two hours and as needed. During an evening observation, this resident was found wearing two briefs. The LPN confirmed CNAs should not place two briefs on the resident. The resident reported that CNAs sometimes put two briefs on her, that she had not reported this to anyone, and that she did not request the CNA to put two briefs on her. A CNA later stated she had placed two briefs on this resident because the resident did not like her bed to get wet, while also acknowledging she was not supposed to do so. Another resident with diagnoses including hemiplegia, hemiparesis, urinary tract infection, and malignant neoplasm of the prostate had a quarterly MDS showing intact cognition (BIMS 15), was dependent on staff for toileting, and care planned for urinary incontinence with use of adult briefs and staff-provided pericare as needed. This resident was also observed wearing two briefs, and the LPN confirmed this should not have occurred. The resident stated he did not ask the CNA to put two briefs on him, while the same CNA reported she had placed two briefs on him because he did not like his bed to get wet and acknowledged she was not supposed to do so. A third resident with diabetes mellitus and vascular dementia, severe cognitive impairment (BIMS 7), bowel and bladder incontinence, and a care plan requiring changing every two hours and as needed was observed during peri care to be wearing two briefs. The CNA who placed the briefs stated she did so because the resident was a heavy wetter and acknowledged she was not supposed to place two briefs on the resident. Another CNA and the LPN confirmed CNAs should not place two briefs on residents.
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