Deficiencies in Catheter Management and Hygiene Care
Penalty
Summary
The facility failed to provide appropriate care and services for two residents, leading to deficiencies in their treatment. Resident #162 was admitted with an order for an indwelling catheter, which was not properly managed. Observations revealed that the catheter tubing was not securely anchored, causing it to pull tightly when the resident was repositioned. Additionally, the catheter bag contained cloudy urine, which was not reported to the physician by the LPN, despite acknowledging the issue. The Unit Manager confirmed a delay in reviewing lab results, which indicated a positive culture requiring antibiotic treatment. Resident #11, who was severely cognitively impaired and frequently incontinent, also received inadequate care. During a personal hygiene routine, a CNA used improper techniques, such as pouring water from a towel onto the resident's private area and failing to clean external structures thoroughly. The CNA did not dry the area before applying protective cream and securing a new adult brief. The Director of Nursing and the Infection Control Preventionist agreed that the care process was improperly executed after observing a demonstration of the CNA's actions. These deficiencies highlight the facility's failure to ensure proper catheter management and personal hygiene care for residents, as required by their comprehensive assessments. The lack of secure catheter anchoring and failure to address cloudy urine in Resident #162, along with the improper hygiene care for Resident #11, demonstrate a need for improved staff training and adherence to care protocols.
Plan Of Correction
Changed and recollected on. Her bag will be anchored as required. Her will be ordered in a timely manner. Resident #11 will have her completed per the center's process. Residents with or will have or care observations completed by the Director of Education/designee to ensure clinical competency for this standard of practice. Any lack of competency by the team member will be corrected immediately. Residents pending results will have their results reviewed timely to ensure timely ordering of. Any results with a delay in treatment will result in a physician notification. The director of education or designee will complete the following educations for nursing team members by. Licensed nurses will be educated on the signs and symptoms of a and to report laboratory results timely to the provider. Nursing team members will be educated on how to anchor a. Certified nursing assistants will be educated on proper procedures. Results will be audited to ensure timely review and ordering of an weekly x4 weeks and monthly x12 months by the Director of clinical services/designee. Anchors will be audited weekly x4 weeks and monthly x12 months by the Director of clinical services/designee. Provided to residents with be audited weekly x4 weeks and monthly x12 months by the director of clinical services/designee. All audits will be brought to the QAPI committee monthly for review.