Failure to Develop Comprehensive Catheter Care Plan
Penalty
Summary
The facility failed to develop a comprehensive care plan for catheter care for a resident with multiple complex medical diagnoses, including malignant neoplasm of the endometrium, diabetes, chronic obstructive pulmonary disease, neurogenic bladder, and urinary retention. The resident was admitted with an indwelling urinary catheter, and physician orders specified monitoring urine characteristics every shift, catheter irrigation as needed, catheter care every shift, and scheduled catheter and bag changes. Despite these orders and the resident's use of a catheter, review of the care plan revealed that no care plan addressing catheter care was in place. The Director of Nursing confirmed during interview that a catheter care plan had not been developed for this resident.