Failure to Provide Proper Catheter Care and Adhere to Physician Orders
Penalty
Summary
A deficiency was identified when a resident with multiple sclerosis, spastic paraplegia, and neuromuscular dysfunction of the bladder, who had a suprapubic catheter, did not receive care in accordance with physician orders and facility policy. The resident's care plan and physician orders required the use of a StatLock device to secure the catheter, to be changed weekly and as needed. During surveyor observations, the resident was found without a StatLock securing the catheter tubing, and staff did not notice its absence until it was pointed out by the surveyor. Additionally, during the process of emptying the resident's urinary collection bag, a CNA failed to cleanse the end of the spigot with an alcohol pad before returning it to the holder, contrary to facility policy and the procedure described by the Director of Nursing. The CNA emptied the urine into a graduate and then into the toilet, but did not clean the spigot, which was confirmed by both observation and staff interview. These actions did not meet the standards outlined in the facility's urinary catheter care policy.