Failure to Provide Proper External Catheter Care and Monitoring
Penalty
Summary
The facility failed to provide appropriate care and monitoring for a female resident using a Pure Wick external urinary catheter. The resident, who had diagnoses including acute cystitis with hematuria, overactive bladder, neuromuscular dysfunction of the bladder, and was a carrier of carbapenem-resistant enterobacterales (CRE), reported that staff did not respond promptly to her requests for assistance. She described being left in feces for extended periods, sometimes up to five hours, and noted that the Pure Wick device was not always functioning properly, leading to leakage and the need for additional pads. The resident also had to instruct CNAs on how to properly reattach tubing and clean the canister, indicating a lack of staff competency and adherence to proper procedures. Observations and interviews revealed that the Pure Wick canister was often left full or over halfway full, and staff did not consistently empty or clean it as required. The resident reported that the canister had not been cleaned for two or three days at times, and staff were not coming in to provide care until late in the evening. The Unit Manager acknowledged there were no specific orders or protocols in the resident's record regarding cleaning the Pure Wick canister, when to empty it, or when to replace the canister and tubing. Additionally, there was no documentation of staff education or resident monitoring related to the use and care of the Pure Wick system, despite the resident's history of multiple urinary tract infections and CRE. Review of facility policy and manufacturer guidelines confirmed that the Pure Wick external catheter should be replaced every 8 to 12 hours or immediately if soiled, and that canisters and tubing should be cleaned and disinfected at least daily and replaced every 60 days. However, the facility's practice did not align with these standards, as staff were not consistently following the required procedures for replacement, cleaning, and monitoring. The Director of Nursing was unable to confirm whether staff were ensuring timely replacement of the external catheter or proper documentation, and there was a lack of clear protocols and staff education regarding the care of the Pure Wick system.