Failure to Clarify Catheter Orders and Timely Follow-Up on Urinalysis
Penalty
Summary
The facility failed to clarify and document appropriate orders for indwelling urinary catheter care and did not follow up on a urinalysis order in a timely manner for a resident with a history of benign prostatic hyperplasia, recent urinary tract infection, and overflow incontinence. The resident required an indwelling urinary catheter and was always incontinent of bowel. Upon review, the care plan did not identify the need for an indwelling catheter or provide interventions for catheter care, and the physician's order lacked details such as catheter size, type, and frequency of change. The treatment administration records for two months also did not specify these details, and the facility's policy on catheter care was not consistently followed. Observations revealed the resident's catheter tubing and drainage bag were stored under the wheelchair, with urine appearing cloudy. Nursing notes documented cloudy and foul-smelling urine, resident complaints of discomfort, and delays in obtaining a urinalysis due to a fax being sent to the wrong provider. The last documented catheter change was prior to admission, and there was confusion among staff regarding the frequency of catheter changes and the need for specific physician orders. The resident experienced discomfort and mucousy discharge upon catheter change, and a urinalysis was eventually collected after the new catheter was inserted. Interviews with nursing staff and the DON confirmed a lack of clear orders for catheter size and change frequency, as well as uncertainty about follow-up with urology. The facility's policy required observation and reporting of complications associated with urinary catheters, but this was not consistently implemented. The administrator acknowledged that orders for catheter care and documentation should have been in place, and the care plan should have reflected the use and management of the urinary catheter.