Failure to Provide and Document Nephrostomy Tube Care
Penalty
Summary
The facility failed to provide appropriate care and services for a resident with a nephrostomy tube. Upon admission, the resident had a urinary obstruction requiring a nephrostomy tube, as documented in hospital discharge records and admission notes. However, there were no physician orders for nephrostomy tube care, such as flushing or dressing changes, and no care plan was developed to address the device. Throughout the resident's stay, there was no documentation of any nephrostomy tube dressing changes or flushes in the clinical record, and nursing notes did not indicate that these essential care tasks were performed. Interviews with nursing staff revealed that neither the RN nor the LPN responsible for the resident's care had performed or documented dressing changes or tube flushes. The RN stated she had not received specific orders or a schedule for nephrostomy tube care and assumed another provider was managing it. The LPN confirmed she only visually monitored the site and did not perform routine maintenance, as there were no care plan instructions or physician orders. Both staff members acknowledged that routine care should have been in place and documented, but it was not. The Director of Nursing confirmed that the facility's standard practice requires physician orders and regular care routines for invasive devices, including scheduled dressing changes and tube flushes, with documentation for each instance. Upon review, the DON acknowledged the absence of orders and documentation for nephrostomy care and described this as a failure in care. The Medical Director also stated that nephrostomy tubes require routine care and monitoring, and expected nursing staff to proactively obtain necessary orders and provide care. The lack of documentation and care for the nephrostomy tube was confirmed as a failure to follow professional standards of practice.