Failure to Provide Ordered Nephrostomy Tube Care and Securement
Penalty
Summary
A deficiency occurred when a resident with multiple complex medical conditions, including Parkinson's Disease, Type 1 and Type 2 Diabetes Mellitus, neurogenic bladder, and bilateral nephrostomy tubes, did not receive nephrostomy care in accordance with physician orders and professional standards. The resident's care plan required nephrostomy tube care every shift, and physician orders specified cleansing the insertion site with 1/4 strength Dakins solution, covering with calcium alginate, and then with 4x4 border gauze, ensuring no adhesive was on the tubing. Additionally, the orders required the use of securement devices for the nephrostomy tubes, to be replaced as needed if soiled or losing adherence. During observation, it was found that both nephrostomy sites were covered with a large ABD pad adhered with tape, rather than the ordered dressing materials. Furthermore, the right nephrostomy tube did not have a securement device in place, contrary to the physician's order. The LPN providing care had to obtain and apply the securement device during the observation. The DON confirmed that the nephrostomy tubes should always have securement devices and should not be covered by ABD pads. No additional information was provided by the facility regarding these concerns.