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F0690
D

Foley Catheter Inserted Without Physician Order or Notification

Hancock, Michigan Survey Completed on 05-29-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency occurred when a resident with a history of urinary tract infections, Alzheimer's disease, dementia, and anxiety disorder was found to have a Foley catheter inserted without a physician's order or appropriate diagnosis. The resident's cognitive skills were severely impaired, and the responsible party was not notified prior to the catheter insertion. The family member expressed concern upon learning about the catheter placement, stating that she had not been contacted for permission. The Director of Nursing confirmed that the physician was not called to obtain an order for the catheter, and acknowledged that there was no diagnosis justifying its use. The registered nurse who inserted the catheter reported making the decision independently due to the resident seeping urine, without consulting the physician or notifying the responsible party. Facility policy requires confirmation of a provider's order and an appropriate diagnosis before catheter insertion, which was not followed in this instance.

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