Failure to Provide Proper Catheter Care and Timely UTI Treatment
Penalty
Summary
The facility failed to obtain ordered laboratory testing to identify a urinary tract infection (UTI) and did not provide proper care and treatment for an indwelling urinary catheter for one resident. This resident had a history of recurrent UTIs, neurogenic bladder, and required an indwelling catheter. Despite orders from the certified nurse practitioner (CNP) on two occasions to obtain a urinalysis with culture and sensitivity, nursing staff did not collect the required urine samples. The resident subsequently developed urinary pain and was sent to the emergency department, where a malpositioned catheter was identified and the resident was treated for cystitis and UTI. Observations revealed repeated improper placement of the urinary drainage bag above the bladder level, both in bed and in a wheelchair, which was confirmed by nursing staff and acknowledged as a recurring issue. Additionally, the facility failed to timely initiate treatment for a UTI for another resident. Laboratory results identified a specific organism and indicated the appropriate antibiotic, but there was a delay between the urine culture result and the administration of the first dose of the prescribed antibiotic. Documentation showed that the medication was not available on the day it was ordered, and the first dose was not given until two days after the culture result. The delay in starting antibiotic therapy was confirmed by the Director of Nursing (DON). Both deficiencies were identified through record review, staff interviews, and direct observation. The failures included not following physician orders for laboratory testing, not maintaining proper catheter care and positioning, and not ensuring timely administration of prescribed medications for UTIs. These actions and inactions directly affected the care and treatment of the residents involved.