Routine Catheter Changes Without Clinical Indication
Penalty
Summary
A deficiency was identified when a resident with an indwelling Foley catheter did not receive care and treatment consistent with professional standards of practice to prevent complications or urinary tract infections. The resident's Foley catheter was changed on a routine monthly basis without documented clinical indications, contrary to the Centers for Disease Control and Prevention (CDC) and Healthcare Infection Control Practices Advisory Committee (HICPAC) guidelines, which recommend changing catheters only based on clinical indications such as infection, obstruction, or compromise of the closed system. The facility's own policy also states that catheters should not be routinely changed, but rather changed according to physician orders or as needed. Record review showed that the physician order for the resident specified a catheter change every four weeks, but there was no documented physician rationale or clinical indication for this routine schedule. The Director of Nursing (DON) confirmed that the policy is to change catheters as needed or per physician order, but was unable to provide a clinical rationale for the monthly catheter changes. The resident had multiple diagnoses, including vascular dementia, congestive heart failure, peripheral vascular disease, urinary retention, benign prostatic hyperplasia, rheumatoid arthritis, and cognitive communication deficit.