Failure to Develop Comprehensive Care Plan for Foley Catheter Use
Penalty
Summary
Facility staff failed to develop a comprehensive care plan with goals and interventions to address a resident’s use of an indwelling Foley catheter. The resident was admitted from a hospital on a stretcher with a Foley catheter draining yellow urine and had multiple diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting the left non-dominant side, gastrostomy status, and aphasia. An admission note documented the presence of the Foley catheter, a subsequent MDS assessment coded the resident as having an indwelling catheter, and a physician’s order specified the Foley catheter was in place due to obstructive uropathy. During observation, the resident was seen in bed with a Foley catheter to bedside drainage. Review of the medical record showed no documented evidence that a comprehensive care plan with measurable goals and specific interventions was developed to address the resident’s Foley catheter use, and the DON confirmed that the last care plan meeting occurred shortly after admission and that staff had not created such a care plan for the catheter. This deficiency was identified for one of twelve sampled residents during the survey and was cross-referenced to 22B DCMR Sec. 3210.4.
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