Failure to Provide Dignified, Care-Planned Toileting for a Cognitively Intact Resident
Penalty
Summary
The deficiency involves the facility’s failure to honor a resident’s right to dignity and to follow her care-planned toileting preferences. The facility’s dignity policy required staff to provide care in a manner that maintains or enhances each resident’s dignity and respects individual needs and choices. The resident, who had COPD, osteomyelitis of the lumbar vertebra, panlobular emphysema, and chronic myeloid leukemia, was cognitively intact with a BIMS score of 15 and was aware of when she needed a bowel movement. Her care plan for constipation related to opioid use included an intervention to encourage her to sit on the toilet to evacuate bowels if possible. However, the Kardex used by nursing staff directed that she required assistance by two staff using a bedpan for toileting, which was inconsistent with the care plan interventions. According to the police body worn camera narrative, officers responded to a complaint from the resident about lack of care. The resident reported that staff placed absorbent incontinence pads (chucks) under her instead of providing a bedpan and that she had been sitting in her bowel movement for quite some time, stating her chucks had last been changed over three hours earlier. During interviews, the resident stated that sometimes staff gave her a bedpan but other times only placed an incontinence pad underneath her, and that this was uncomfortable and embarrassing. She expressed a preference to be transferred with a lift to use the toilet and reported that a recent sit-to-stand lift transfer had worked well. An LPN confirmed there had been miscommunication that resulted in the resident not receiving the care she needed and stated that residents needed more attention than staff could provide. These actions and inactions resulted in the resident not being toileted in accordance with her care plan and preferences, and not being treated in a manner that maintained her dignity.
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