Failure to Ensure Staff Competency in Nephrostomy Care
Penalty
Summary
Licensed nurses and nurse aides at the facility failed to demonstrate the necessary competencies and skills to provide appropriate nephrostomy care for a resident with bilateral nephrostomy tubes. Despite facility policy requiring sterile technique for dressing changes, multiple staff members, including LVNs, an RN, and the ADON, were unaware of this requirement and did not perform dressing changes using sterile technique. Interviews revealed that staff either did not change the dressings at all or used non-sterile methods, and there was a lack of knowledge regarding the facility's nephrostomy care policy. The resident involved was an older female with a history of hydronephrosis, chronic kidney disease, urinary tract infection, and type 2 diabetes. Her care plan and physician orders specified nephrostomy site care with sterile dressing changes twice daily. However, observations on multiple days showed that there were no dressings present at either nephrostomy site, and the resident reported that staff only applied cream or lotion to her back, with no dressing changes performed as ordered. Documentation indicated that staff signed off on dressing changes that were not actually completed. Further review found that the ADON, RN, and DON were not aware of or had not provided training on the facility's nephrostomy care policy, and there had been no in-services on this topic in the past six months. The DON acknowledged that staff were not trained on nephrostomy care upon hire and that she had not recently provided in-services on the policy. The facility had supplies available for sterile dressing changes, but staff did not utilize them due to lack of awareness and training.