Failure to Maintain Proper Positioning of Nephrostomy Drainage Bag
Penalty
Summary
Clinical staff failed to follow infection control protocols regarding the proper positioning of a nephrostomy drainage bag for a resident with urinary drainage needs. During a survey, it was observed that the resident's nephrostomy bag was placed on a towel on top of a floor mat next to the bed, rather than being hung off the floor as required. An LPN explained that the bag was placed on the towel to prevent urine from leaking onto the floor, and indicated that the bag had been properly hung at the end of her previous shift, suggesting the night shift may have moved it. The LPN did not correct the positioning of the bag during the observation. Further observations revealed that, on a subsequent day, the nephrostomy bag was hanging from the bedrail but the cap of the bag was touching the floor. Unit managers confirmed that urinary drainage bags should not be in contact with the floor. The infection control nurse was later notified of the issue and acknowledged the non-compliance with infection control policies regarding the proper hanging of nephrostomy drainage bags.