Failure to Provide Catheter Care and Bowel/Bladder Retraining
Penalty
Summary
The facility failed to provide proper care and services for a resident with an indwelling catheter by not administering catheter care as ordered by the physician. The resident, who had diagnoses including urinary retention and a history of urinary tract infection (UTI), required catheter care every shift, including cleansing the area and monitoring for signs of infection. Documentation revealed that on three specific shifts, there was no evidence that licensed nurses provided or documented the required catheter care or monitoring for redness, irritation, swelling, or symptoms of UTI. Both the MDS Coordinator and the Director of Nursing confirmed that the care was not documented and acknowledged that licensed nurses are required to implement physician orders and document the care provided. Additionally, the facility did not implement a bowel and bladder retraining program for two residents who were identified as candidates for such a program upon admission. Both residents had assessments indicating they could comprehend and follow instructions and were suitable for retraining programs. However, after the initial 72-hour assessment period, the staff failed to review the Bowel and Bladder Assessment forms when determining the need for retraining, resulting in neither resident being started on a program. Interviews with the MDS Coordinator and a registered nurse confirmed that the assessments were overlooked, and the required programs were not initiated as per facility policy. The facility's policies and procedures required that catheter care be documented in the resident's medical record, including assessment data and the resident's response to care, and that a toileting program be established within four days of admission for eligible residents. In these cases, the required documentation and program initiation did not occur, as confirmed by staff interviews and record reviews.