Urine Catheterization Performed Without Physician Order
Penalty
Summary
A Licensed Vocational Nurse (LVN) attempted to obtain a urine specimen from a resident by performing a straight catheterization without a physician's order. The resident, who was cognitively intact and had a history of hemiplegia, metabolic encephalopathy, and malignant neoplasm of the brain, recalled being confused and nervous during the procedure, as she had previously been able to provide urine specimens using a hat. The LVN made two unsuccessful attempts to insert the catheter before ultimately collecting the specimen via bedpan, without notifying the physician or the resident's responsible party. The LVN stated she was unaware that a physician's order was required for this procedure, as it had been standard practice at her previous place of employment for incontinent residents. Facility policy and procedure documents reviewed indicated that a physician's order is required for invasive procedures such as straight catheterization and for obtaining urine specimens. The Director of Nursing confirmed that the LVN had attempted the procedure without an order and acknowledged that straight catheterization is considered invasive. The facility's administrator also acknowledged that the LVN's actions were not in line with facility expectations, which require staff to follow physician orders, adhere to policy, and document all interactions and communications.