Failure to Prevent Latex Exposure in Resident with Documented Allergy
Penalty
Summary
A resident with a documented latex allergy was given an indwelling latex urinary catheter, contrary to physician orders specifying the use of a silicone catheter. The resident's allergy to latex was clearly indicated in their medical record, care plan, and allergy documentation. Despite this, staff failed to verify the allergy prior to the catheter insertion, resulting in the use of a latex catheter. The resident was cognitively intact and able to communicate their allergy, which had been listed since admission. Following the insertion of the latex catheter, the resident developed redness and irritation on their right thigh where the catheter tubing had been in contact with the skin. The issue was identified when staff noticed the redness and realized the catheter was latex rather than silicone. The physician was notified, and treatment for the skin irritation was ordered. Interviews with staff confirmed that the error occurred due to a failure to check the resident's allergies before the procedure.