Failure to Provide Proper Catheter Securement and Perineal Care
Penalty
Summary
The facility failed to provide appropriate care for residents who were incontinent of bowel and bladder, specifically in the areas of catheter care and perineal hygiene, as observed in two residents. Both residents had indwelling Foley catheters and were dependent on staff for all activities of daily living, including toileting and hygiene. Observations revealed that the catheter drainage tubes for both residents were not properly secured with a Catheter Holder prior to turning and repositioning in bed. The Catheter Holders were found to be loose or detached, and staff interviews confirmed that this was a recurring issue, particularly after showers or when lotion was applied. Staff were aware of the need to report and replace detached Catheter Holders, but this was not consistently done in practice. In addition to issues with catheter securement, perineal care was not performed according to facility policy for one resident. During an observed episode of incontinence care, a CNA cleaned the perineal area from back to front, rather than from front to back as required by policy and training. This method of cleaning increases the risk of cross-contamination from fecal matter to the urethral and vaginal areas. The CNA used multiple wipes but did not adhere to the correct technique, despite having been trained on the proper procedure. Interviews with other staff confirmed that the expectation was to always clean from front to back to prevent contamination and infection. Record reviews for both residents indicated a history of significant medical conditions, including chronic kidney disease, neuromuscular dysfunction of the bladder, and a history of antibiotic-resistant urinary tract infection. Care plans and physician orders specified the need for catheter care every shift and the use of Catheter Holders to prevent trauma and infection. However, the care plans did not always address the presence of a Foley catheter, and the observed practices did not align with facility policy or physician orders. The facility was unable to provide a current catheter care policy upon request by the surveyor.