Improper Maintenance of Indwelling Urinary Catheter and Drainage Bag
Penalty
Summary
The deficiency involves the facility’s failure to maintain an indwelling urinary catheter in a sanitary and appropriate manner for one resident with multiple complex medical conditions, including metabolic encephalopathy, severe protein calorie malnutrition, benign prostatic hyperplasia, obstructive and reflux uropathy, hydronephrosis, hypertension, dementia, myocardial infarction, and resistance to Vancomycin. The resident had severely impaired cognition, behavioral symptoms, rejected care on some days, was dependent on staff for ADLs, used an indwelling urinary catheter, was bowel incontinent, and was at risk for pressure ulcer development. The care plan, initiated and later revised, included interventions to keep the catheter bag and tubing below the level of the bladder, provide a privacy bag, and secure the drainage catheter to the resident’s leg. Physician orders directed that the urinary catheter be on continuous drainage, and an antibiotic was ordered for a UTI with bacteremia. Surveyor observations on multiple occasions showed the catheter drainage bag was not maintained according to policy or care plan. On one evening observation, the drainage bag was lying on the floor under the bed, and a later observation that same evening confirmed it remained on the floor. A CNA acknowledged the resident was on contact isolation for a urine infection (MRSA), verified the bag was on the floor, and stated it should have been secured to the bed frame. A subsequent observation found the drainage bag again on the floor next to the bed. On another morning, the drainage bag was observed at the end of the bed at the level of the resident’s bladder rather than below it. The CNA confirmed the bag was not below bladder level and stated it should be to prevent backflow of urine. An RN confirmed that facility policy required the collection bag not be on the floor, to be draining properly, and to be secured below bladder level to prevent reflux, consistent with the written catheter care policy reviewed by surveyors.
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