Catheter Removed Without Physician Order
Penalty
Summary
Staff failed to obtain a physician's order prior to removing an indwelling urinary catheter from a resident with a history of bacteremia, chronic kidney disease, and neuromuscular dysfunction of the bladder. The resident, who was always incontinent of bowel and bladder and dependent on staff for all activities of daily living, had an intact cognitive function and was under hospice care. The care plan indicated the presence of an indwelling Foley catheter due to neurogenic bladder, with interventions to monitor for pain or discomfort related to the catheter. On the day of the incident, a nurse contacted urology to request an order for catheter removal but did not receive a return call or order. Later, the resident reported severe urinary pain, and after administering pain medication, the nurse removed the Foley catheter at the resident's request without a physician's order. The resident was subsequently transferred to the hospital to rule out a urinary tract infection. Review of facility protocol confirmed that a physician's order is required for catheter removal, and the Director of Nursing verified that no such order was present in the medical record.