Failure to Ensure Staff Competency in Nephrostomy Care
Penalty
Summary
The facility failed to ensure that nurses and nurse aides possessed the necessary competencies to provide appropriate care for residents with nephrostomy tubes, as evidenced by the care of two residents. Both residents had complex medical histories, including hydronephrosis, urinary tract infections, and nephrostomy catheters, and required specialized care and monitoring. Despite these needs, staff demonstrated a lack of understanding regarding the correct management of nephrostomy tubes, including the proper positioning of stopcocks to allow for drainage, and failed to consistently monitor and document output as ordered. For one resident, repeated hospitalizations occurred due to issues with the nephrostomy tube, including the stopcock being left in the off position, resulting in a significant accumulation of purulent fluid and infection. Observations revealed improper dressing and anchoring of the tubing, and staff were unable to confidently assess or describe the correct functioning of the nephrostomy equipment. Documentation was incomplete, with missing transfer forms and inconsistent charting of care, assessments, and outside transfers. The unit manager and other staff members were unclear about the standards of care for nephrostomy tubes and had not received adequate education on the subject. For the second resident, there was a prolonged period where the nephrostomy bag output was documented as zero for multiple shifts, despite the presence of the tube and orders to monitor output. Staff interviews and observations revealed confusion about the correct position of the stopcock and a lack of confidence in assessing the device. Review of training files for relevant nursing staff showed no evidence of education on nephrostomy care, further supporting the finding that staff were not competent to manage the residents' needs as required.