Failure to Provide Proper Catheter Care and Securement
Penalty
Summary
The facility failed to provide appropriate care for residents with indwelling urinary catheters, as evidenced by observations and interviews involving two residents. For one resident with multiple sclerosis and neurogenic bladder, the catheter drainage bag was not covered with a dignity bag, and the catheter tubing was not anchored to the resident's leg as required by facility policy. The resident reported that catheter care had not been performed for several days, despite orders and care plans specifying catheter care every shift and the use of a drainage bag cover. Observations confirmed the absence of a drainage bag cover and anchor during wound care provided by the ADON and RN. Another resident with urinary retention, chronic kidney disease, and a history of urinary tract infection was observed with catheter tubing hanging down and touching the floor, visible sediment in the tubing, and no dignity cover on the drainage bag. The resident also reported not receiving catheter care for several days. During further observation, the catheter tubing was still not anchored, and the resident experienced discomfort from the tubing pulling when standing. The DON confirmed that catheter care should be performed every shift, the tubing should be anchored and not touch the floor, and the drainage bag should be covered, all of which were not followed for these residents.