HospitalInspections.org

Based on medical record review, staff and patient interviews, and policies, the nursing staff failed document that patients were receiving baths daily per facility policy.

A review facility policy number, S05-G, "Guidelines and Protocols," revised 7/01/21, revealed bathing was to be completed daily, and shampooing hair would be completed weekly. Bed linens, draw sheets, incontinent pads, and gowns were to be changed daily and as needed (PRN). Oral care would be completed twice a day and PRN. Oral care for tube feedings and nothing by mouth (NPO) were to be completed every four hours. Washcloths and mouthwash were to be offered after each meal. Peri-care was to be completed every shift and PRN for external urinary catheter devices (Foley).

Review of the Comfort and Hygiene sections of the medical record from 10/25/21 to 11/13/21 revealed that P#1 had bowel and urinary incontinence daily and skin and peri-care were not documented as completed on 10/25, 10/26, 11/1, 11/2, 11/5, 11/6, 11/7, 11/8, and 11/9. All other days of admission, skin/incontinence cleanser wipes and peri-care were documented one to two times daily. There was one day, 11/3/21, where "bathed" was documented. Review of the Comfort and Hygiene and nursing notes failed to reveal that P#1 had refused baths.

During an interview with the Certified Nursing Assistant (CNA) GG on 11/30/21 at 2:45 p.m. in the Conference Room, CNA GG said that when "bathing" is documented, it means a washcloth, soap and water were used to bathe the patient while in bed. CNA GG said all baths at the facility are bed baths. Some staff members would only use bath wipes during bathing and would document that skin cleanser wipes were used. Peri-care would be documented when cleansing wipes were used to clean the perineal area after incontinence. CNA GG said patients were always bathed, but CNA GG may have forgotten to document.

A telephone interview took place with CNA EE on 11/30/21 at 3:41 p.m. CNA EE said that when a patient was alert and oriented, the patient could request baths as often as they wanted. Baths consisted of wiping down the full or partial body of the patient, depending on how dirty or if there was incontinence. Most of the time, warm wipes would be used, but if a patient was very dirty, the technicians would use exfoliating washcloths. CNA EE said the patients did not have showers, and the technicians always used bed baths. CNA EE further said that when entering the baths into the computer system, the techs would click on the options given by the computer program, whether it was peri-care, bathing, or skin/incontinence cleanser wipes. If nothing was entered, CNA EE said it was most likely that the patient refused instead of that the bath was not documented. CNA EE said she only worked with P#1 twice, and P#1 wanted to be left alone. CNA EE said P#1 refused baths a few times, because P#1 did not like to be uncovered. CNE EE said P#1 had the hospital blankets and blankets from home and did not want the blankets removed.

During an interview with P#4 on 12/1/21 at 12:15 p.m. in the patient's room, P#4 said staff would assist in bathing at the bedside once weekly using soap and water but did not assist with bathing the other days of the week with bath wipes or soap and water. P#4 further said a family member would assist with oral care daily.