| 93 |
SENIOR REHAB & RECOVERY AT LIMESTONE HEALTH FACILI |
15024 |
1600 WEST HOBBS STREET |
ATHENS |
AL |
35611 |
2018-02-15 |
690 |
D |
0 |
1 |
EZGG11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation of incontinent care on 02/14/18, medical record review, staff interviews, and review of facility policies titled Urinary Catheter Care, and a facility document titled Perineal/Catheter Care, the facility failed to ensure the Certified Nursing Assistant (CNA) properly cleaned Resident #33's catheter tubing. Further, the CNA failed to clean Resident #33's perineal area of fecal matter, prior to the completion of care. These failures were observed during one of one catheter and incontinence care observations. Findings Include: A review of a facility policy titled: Urinary Catheter Care with an effective date of (MONTH) 16, 2014 documented: . PURPOSE: Urinary catheter care helps to prevent urinary tract infection . PR[NAME]ESS: . II. Catheter Care . c) Wash the catheter itself by holding on to the catheter at the insertion site; wash with one stroke downward . A review of a facility document titled: . Perineal/Catheter Care . with a date of 12/18/16 documented: . CATHETER CARE . 2 . Gently . to expose meatus . A review of RI #33's Quarterly Minimum Data Set with an assessment reference date of 11/22/17 revealed RI #33 was severely impaired in cognition, incontinent of bowel and dependent upon staff for hygiene. A review of the hospital DISCHARGE SUMMARY dated 01/04/2018 documented: . DISCHARGE Diagnosis: [REDACTED]. RI #33 was readmitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 02/14/2018 at 5:45 p.m., Certified Nursing Assistant, Employee Identifier (EI) #7 provided incontinent care for RI #33. The resident rolled his/her self to left side and EI #7 wiped the buttock area three times front to back, using a clean wash cloth with each wipe. Bowel movement was visible on each wash cloth used. RI #33 had a foley catheter in place. EI #7 then cleaned the catheter tubing toward the residents perineum. RI #33 rolled onto his/her back. Without changing the soiled gloves or washing her hands, EI #7 then placed a clean brief under RI #33 and put a clean gown on the resident. EI #7 wiped down the left side of the outer perineal area and across. EI #7 then wiped down the right outer perineal area and across. EI #7 fastened the brief, removed the (soiled) gloves and without washing her hands, she applied clean gloves. At the completion of care, the surveyor asked EI #7 if she had visualized the perineal area. EI #7 said no. EI #7 then unfastened the brief, separated the perineal area, and wiped front to back three additional times (using a clean wash cloth each time). Additional bowel movement was apparent on the wash cloth each time. On 02/14/2018 at 6:00 p.m., EI #7 was asked which direction had she wiped the catheter. EI #7 said, she had wiped (incorrectly) back to front (from the residents perineum down the catheter tubing), and she should not have because of contamination. EI #7 was asked why it was important to ensure all bowel movement was removed from the perineal area. EI #7 explained it was necessary to avoid infection and skin breakdown. When asked if she had washed her hands after changing the soiled gloves, EI #7 said no. EI #7 said she should have changed the gloves, due to contamination. EI #7 was asked if she should she have handled the clean brief, clothes and clean linen with soiled gloves. EI #7 said no, due to the contamination of those items. On 02/15/2018 at 5:37 p.m., an interview was done with EI #2, the Director of Nursing/Infection Control. EI #2 stated the staff should wash their hands after taking off soiled gloves and before putting on clean gloves in order to prevent the spread of infection. EI #7 said staff should never touch clean items/linen with soiled gloves so as to prevent the spread of infection. EI #7 was asked what was the facility's policy on catheter care. EI #7 said staff were to wipe front to back, and always visualize the perineal area because you do not want germs near the urinary tract. |
2020-09-01 |