cms_GU: 78
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 78 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2012-01-26 | 315 | G | 0 | 1 | J2NN11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility did not ensure that a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections [MEDICAL CONDITION] and to restore as much normal bladder function as possible; 1. When the facility did assess or refer a resident for bladder training or adaptive equipment resulting in accidental incontinence for one of 10 residents (Resident 2), and 2. When the facility did not prevent the development of UTIs for one of 10 residents (Resident 6). Findings include: 1. Resident 1 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the minimum data set ((MDS) dated [DATE] revealed that the resident was alert and oriented, dependent on staff for most activities of daily living, and continent of bladder function. The care area assessment (CAA) summary for the current admission noted that urinary incontinence will not be care planned because the resident is continent. Review of the medical record revealed that on 1/16/12, Resident 2 was described in nurses notes as being incontinent of bladder. On 1/18/12, the resident was also documented in nurses notes as incontinent of bladder and bowel, and on 1/20/12, as being incontinent of urine. In addition, SNU (skilled nursing unit) nurse aide flowsheets dated 1/20/12 through 1/23/12 described Resident 2 as being incontinent of bladder function. Notwithstanding the documentation, review of the medical record revealed the lack of documented evidence that the physician was notified and that an assessment of the resident's bladder status was conducted to identify the cause of the incontinence and determine whether or not the resident could benefit from a bladder training program. In addition, review of the medical record revealed the lack of indication that a care plan was developed to address the change in bladder status which included goals and outcomes as well as interventions to prevent further diminishment of function. During an interview on 1/24/11, Resident 2 stated that while he had been having episodes of urinary incontinence which required him to wear briefs, that he however still feels the urge if he has to urinate. The resident added that he had been having accidents because of the increasing urgency and the delay and difficulty of getting him to the bathroom. In light of this, there was no documentation of any referral to determine if the resident could benefit from therapy services or use of adaptive equipment. 2. Resident 6 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident had a gastrostomy tube ([DEVICE]) for feeding and a urinary catheter for elimination. The resident required total assistance for activities of daily living (ADLs). The resident's family member was with the resident most of the time. During observations and subsequent interviews on 1/24/2012 beginning at 1:30 PM, a licensed nurse (LN) and a certified nursing assistant (CNA) were providing care to Resident 6. The resident was positioned on her right side. The CNA removed the resident's soiled brief. The urinary catheter bag was attached to the right side of the bed, causing the catheter tube to pull from the resident's urethra over the stool and down to the collection bag. Neither the nurse nor the CNA moved the collection bag to the left side of the bed, nearer to the resident and out of area where the staff were working. The CNA used a gloved hand to clean the resident while pouring water over the perineum and the catheter tubing- spreading the stool over the entire perineum including the opening of the urethra, increasing the risk of urinary tract infection [MEDICAL CONDITION]. When asked how often catheter care was provided to Resident 6 and about the method of cleaning the resident, the CNA stated We do it (catheter care) every shift and we not have enough wash cloths to go around so we just use our gloved hand and water. When asked about the catheter pulling the CNA and the LN stated, We should have moved it to the other side. When asked what the procedure was to do catheter care, the LN stated they cleaned the perineum beginning close to the body using soap and water, cleaning around the catheter and then clean the tube from close to the body down the tube. The LN stated they usually use some gauze if a wash cloth was not available. When told of the surveyors observation of potential contamination of the Urethra (opening of the urinary tract) due to the method of cleaning and allowing the catheter tube to be in touch with the anus and stool. The LN stated she would be sure to observe the resident for signs of infection. Review of laboratory results revealed the resident had two previous urinary tract infections [MEDICAL CONDITION] collected C&S 11/16/11 with Escherichia coli (E. coli- an organism found in feces) and 12/6/11 with Pseudomanas aeruginosa; The resident had prior infections of the [DEVICE] site collected C&S 11/9/11 with [DIAGNOSES REDACTED] pneumoniae and Pseudomanas aeruginosa; Review of the Care Plan for SNU-Foley Catheter Use initiated 10/22/2011 and updated 1/20/2012, included the following direction: Clean urinary meatus (opening of the Urethra) .every shift. | 2017-01-01 |