Lack of Specific Physician Order and Care Plan for Suprapubic Catheter
Penalty
Summary
The facility failed to ensure that a physician order and care plan for a resident with a suprapubic catheter included specifications for the catheter size and balloon inflation amount. According to the facility's policy, catheter care must be provided in accordance with current professional standards and resident care policies. However, review of the clinical record for a resident admitted with diagnoses including diabetes, heart failure, and obstructive uropathy showed that the physician order only directed the suprapubic catheter to be changed every four weeks, without specifying the required size or balloon inflation amount. Additionally, the resident's care plan, which was revised during their stay, noted the use of a suprapubic catheter but also failed to include the necessary specifications for catheter size and balloon inflation. This omission was confirmed during an interview with the Director of Nursing, who acknowledged that the required details were missing from both the physician order and the care plan for this resident.