Deficient Catheter Care and Urinary Output Documentation
Penalty
Summary
Surveyors observed that the facility failed to provide appropriate care for residents with indwelling Foley catheters. For one resident with diagnoses including right femur fracture, obstructive and reflux uropathy, urine retention, and chronic kidney disease, the Foley catheter bag was seen resting on the floor during two separate observations while the resident was in a wheelchair. The resident's care plan required documentation of urinary output, but review of records showed incomplete documentation of urinary output on multiple shifts. Facility policy required that catheter bags and tubing not touch the floor and that output be documented each shift, but these procedures were not consistently followed. For another resident with diabetes, heart failure, and acute kidney failure, staff did not obtain a urine sample for urinalysis and culture in a timely manner after the resident complained of pelvic and back pain. The physician ordered a straight catheterization to obtain the sample, but after an unsuccessful attempt, a Foley catheter was inserted the following day. The delay in obtaining the urine sample was acknowledged by the facility's nurse consultant. These findings demonstrate lapses in catheter care, documentation, and timely response to physician orders for residents requiring urinary management.