Deficient Catheter Care, Incontinence Management, and Documentation
Penalty
Summary
Multiple deficiencies were identified regarding the care of residents with urinary incontinence, indwelling catheters, and the prevention of urinary tract infections. One resident with an indwelling catheter was observed with the catheter drainage bag placed directly on the floor, contrary to facility policy and staff expectations that the bag should be kept below the bladder and never on the floor. The same resident's Care Area Assessment (CAA) for urinary incontinence and catheter care lacked required analysis, and the facility was unable to provide this documentation when requested. Another resident with a suprapubic catheter experienced leakage and reported to staff that the appropriate size Foley catheter was not available for replacement, despite physician orders and care plan directives specifying the use of a 22 French Foley catheter. Nursing notes confirmed the need to order the correct catheter size, and the resident used towels to manage the leakage. Staff interviews revealed conflicting information about the availability of the required catheter supplies. Additional deficiencies included the lack of documentation of catheter output for a resident with an indwelling catheter, with multiple missed entries across several months, despite physician orders to record output every shift. Two residents who were incontinent and identified as possible candidates for bowel and bladder retraining did not have toileting programs implemented, and their care plans lacked interventions to address or prevent incontinence episodes. Observations noted strong urine odors and evidence of incontinence in their rooms. The facility also failed to provide or follow policies related to toileting programs and catheter/UTI prevention for these residents.