Unordered and Uncareplanned Use of PureWick Device for Continent Resident
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a continent resident received appropriate services to maintain continence and that the use of a PureWick external catheter was properly ordered and care planned. Resident 53 was admitted with unsteadiness on feet, difficulty in walking, and muscle weakness, and reported being continent of urine upon admission. During a surveyor observation, a suction canister with dark amber fluid and suction tubing was noted at the bedside, and the resident stated she had been non‑weight bearing for a few weeks and was given a PureWick catheter so she did not have to get up to use the toilet. She reported that staff changed the PureWick device a few times a week. Review of the medical record showed no physician order for the PureWick device and no directions for its use, and the resident’s care plan did not include the PureWick. Staff interviews confirmed that the resident had been continent when first at the facility and later began using a PureWick device, with a CNA learning of this only through CNA report and noting the resident also wore briefs. The CNA Coordinator acknowledged there was a resident using a PureWick and that this was new for the facility, stating CNAs had been trained and could ask questions. RN 2 confirmed the resident had used the PureWick for a couple of weeks due to being non‑weight bearing and not wanting frequent brief changes, and stated that PureWicks should have a doctor’s order, but she had not received facility training on its use and was unsure how often it should be changed. RN 3 stated the device should be changed every 24 hours, the canister cleaned once a week, and that use of a PureWick should be care planned. The DON reported the resident had used the PureWick for about two weeks for dignity while bedbound and non‑weight bearing, acknowledged that a doctor’s order was required and that the resident did not have one, and stated that the use of a PureWick should be care planned.
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