Failure to Update Care Plan for Suprapubic Catheter Change
Penalty
Summary
The facility failed to ensure that a resident's comprehensive care plan was revised to accurately reflect the current size of the resident's suprapubic indwelling urinary catheter. The resident had a new catheter of size 18 French inserted on 2/7/25, as documented in the urology procedure report. However, the care plan continued to reference previous catheter sizes and did not include the updated information regarding the new catheter size. During interviews and medical record reviews, facility staff, including an RN, the Administrator, and the DON, acknowledged that the care plan had not been updated to reflect the resident's current catheter size. The facility's policy requires ongoing assessment and revision of care plans as resident information and conditions change, but this was not followed in this instance.