Failure to Provide Adequate Catheter and Perineal Care
Penalty
Summary
A deficiency was identified when a resident with an indwelling urinary catheter was not properly monitored or provided with adequate catheter and perineal care. The resident, who had multiple diagnoses including muscle wasting, atrophy, and congestive heart failure, had physician orders for daily catheter cleansing, perineal hygiene, and monitoring for complications such as redness, irritation, and infection. However, these orders were not reflected in the Medication Administration Record or Treatment Administration Record, and there were no treatment orders for skin redness, irritation, or antifungal use. During observation, the resident was found to have a buildup of a white substance on the genitals and between the groin folds, redness and irritation of the skin, and a strong odor resembling yeast. The Unit Manager noted that catheter care had not been performed, and the resident's skin was not properly cleaned. The assigned nurse aide stated she had performed catheter care and noticed redness but did not report it to the nurse. The nurse responsible for the daily skilled charting admitted she did not visually check the resident's skin integrity during her assessment. Interviews with facility leadership confirmed that catheter care was not being performed as ordered, and staff were primarily emptying the catheter bag without providing full hygiene care. The Director of Nursing and Administrator acknowledged that the resident should have been checked regularly for incontinence and that the need for catheter and perineal care should have been identified. The Medical Director confirmed that lack of proper catheter care could put the resident at risk for infection and that the resident was not refusing care.