| 53 |
BOYINGTON HEALTH AND REHABILITATION |
255092 |
1530 BROAD AVE |
GULFPORT |
MS |
39501 |
2019-03-08 |
690 |
D |
0 |
1 |
M3XR11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, record review, and facility policy review, the facility failed to provide Resident #51 and Resident #109's catheter care in a manner to prevent the possibility of a Urinary Tract Infection [MEDICAL CONDITION], for two (2) of five (5) resident catheter care observations. Findings include: A review of the facility's policy titled Catheter Care, Urinary dated (MONTH) (YEAR) revealed: Equipment and Supplies included pre-moistened wipes. Steps in the Procedure: 1. Wash hands. 17. Clean from the least contaminated to most contaminated area. Review of the facility's policy titled, Perineal Care, dated (MONTH) (YEAR), revealed: Equipment and Supplies included pre-moistened wipes. 18. For Male Resident- Steps in the Procedure - b. Wash perineal area starting with urethra and working outward. (2) Wash and rinse urethral area using a circular motion. f. Instruct, or assist resident to turn on his side. g. Using new washcloth, apply soap or skin cleansing agent or use pre-moistened wipe and wash. h. Using new washcloth, rinse the rectal area thoroughly to include the area under the scrotum, the anus, and the buttocks. If pre-moistened wipes are used, rinsing is not necessary. On 03/07/19 at 2:05 PM, an observation revealed Certified Nursing Assistant (CAN) #1 provided Resident #51's catheter care. CNA #1 entered Resident #51's room, applied her gloves, pulled some clean wipes from the wipe container, and begin the catheter care. CNA #1 did not wash her hands prior to donning the gloves and beginning the catheter care. CNA #1 wiped around the catheter near the resident's penis three times using one wipe, and rotated the wipe as she wiped. She then used another wipe to wipe in a downward motion of the resident's groin areas, using a clean wipe for each side. CNA #1 held the catheter tubing near the meatus, and wiped away from the meatus three times. She then repositioned Resident #51 onto his left side and cleaned his buttocks, wiping the buttocks areas in a circular and back and forth motion, using the same wipe to clean the resident's entire buttocks area. CNA #1 failed to wipe Resident #51's buttocks from front to back, or from least contaminated area to most contaminated area. An interview on 03/07/19 at 3:44 PM, with CNA #1 revealed she should have washed her hands before beginning the procedure. She also stated she should have wiped from front to back in an upward motion. An interview on 03/07/19 at 9:29 AM, with Registered Nurse (RN) #7 revealed Resident #51 was very independent, and does not like for the staff to assist him with anything although he needs it. RN #7 stated he does not think Resident #51 has had any Urinary Tract Infections (UTIs), but he does have spasms. He stated the resident has the catheter because he has some [DIAGNOSES REDACTED] from his [MEDICAL CONDITION]. An interview, on 03/07/19 at 3:49 PM, with the Director of Nursing (DON) revealed CNA #1 should have washed her hands so she does not carry anything in to the resident. The DON stated CNA #1 should have wiped in an upward position for infection control purposes. An interview, on 03/07/19 at 3:26 PM, with RN #2 revealed CNA #1 should have washed her hands, gathered her supplies, and placed her supplies on a barrier, and then proceed to perform the catheter care. RN #2 also stated CNA #1 should have used one wipe to wipe each time in an upward position. Review of the Physician Orders, with a start date of 12/21/18, revealed; change Foley Catheter as needed for leakage or blockage. Foley Catheter, check leg anchor every shift and as needed. Foley Catheter care every shift. Foley Catheter size 16 French (FR) to bedside drainage, check for patency every shift and change as needed. Review of Resident #51's most recent comprehensive MDS, with an ARD of 12/19/18, revealed Resident #51 was coded for an indwelling urinary catheter/condom catheter, and not rated for urinary continence. Further review of the MDS revealed a BIMS score of 15, which indicated Resident #51 was cognitively intact. A review of the facility's Face Sheet revealed the facility admitted Resident #51 on 03/13/18 with a [DIAGNOSES REDACTED]. Resident #109 An observation, on 03/07/19 at 8:45 AM, revealed Resident #109 was lying in bed with the head of bed elevated. Further observation revealed Resident #109's catheter bag was lying in the bed with the resident, and the urine was backing up into the tube into the bladder. An observation, on 03/07/19 at 9:00 AM, revealed Resident #109 was lying in the bed with the catheter bag lying in the bed with the resident, and the urine was backing up into the tube into the bladder. An observation, on 03/07/19 at 9:38 AM, with the Director of Nursing (DON) present, and another surveyor revealed Resident #109 was lying in the bed. The catheter bag was lying in the bed with Resident #109, and the urine was backing up in the tubing into the bladder. An interview, on 03/07/19 at 9:40 AM, with the Director of Nursing (DON) confirmed the catheter was lying in the bed with Resident #109. The DON also confirmed the urine was backing up in the tube into the bladder. The DON confirmed this resident has chronic Urinary Tract Infections. Review of Resident #109's Care Plan revealed a Focus for high risk for infection related to having an indwelling catheter due to Obstructive and Reflux [MEDICAL CONDITION] and Neuromuscular Dysfunction of the Bladder, and History of Urinary Tract Infections (UTIs). Review of the Interventions revealed no intervention for placement of the catheter bag/tubing below the bladder level to prevent backflow of urine and possible UTI. During an interview, on 03/07/19 10:40 AM, Certified Nursing Assistant (CNA) #2 revealed she was looking for a wheelchair because the resident was going out to a doctor's appointment. CNA #2 stated she forgot to move the catheter bag off the bed. CNA #2 said the resident could develop an infection by allowing the urine to back up in the catheter. A review of the Face Sheet revealed the facility admitted Resident #109, on 05/06/2016, with [DIAGNOSES REDACTED]. A review of Resident #109's Quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 02/15/2019, revealed Resident #109 had a Brief Interview for Mental Status (BIMS) score of 15, which indicated the resident is cognitively intact. Further review of the MDS revealed Resident #109 was checked for the use of an indwelling catheter, external catheter, or ostomy. Resident #109's Urinary Continence was checked not rated due to a catheter, urinary ostomy, or no urine output during the seven (7) day observation period. |
2020-09-01 |