Failure to Obtain Timely Physician Orders for Catheter Care Upon Admission
Penalty
Summary
A deficiency occurred when the facility failed to obtain physician's orders for the care and monitoring of an indwelling urinary catheter upon admission for a resident with multiple diagnoses, including chronic kidney disease, diabetes mellitus, urinary tract infection, myoglobinuria, and urogenital implants. The resident was admitted with an indwelling catheter, as documented in the admission observation and data collection form. The care plan noted the presence of the catheter and included approaches such as recording urinary output and providing care per physician's orders. However, physician's orders related to the catheter, its care, and monitoring were not entered until five days after admission. Interviews with the DON and an RN confirmed that standing orders for the catheter should have been initiated upon admission and that the lack of these orders resulted in the absence of catheter care and assessment documentation in the Medication Administration Record (MAR). Facility policies required the admitting nurse to review and implement standing orders with the physician at admission, and to assess the need for continued catheterization. These procedures were not followed, leading to the deficiency.