Failure to Obtain Physician Orders for Catheterization
Penalty
Summary
The deficiency involves the facility’s failure to consult with a resident’s physician and obtain required physician orders before performing an in-and-out catheterization and inserting a Foley catheter. The resident was an elderly male with chronic kidney disease stage 3B, gout due to renal impairment, vascular dementia with severely impaired decision-making, and total dependence on staff for hygiene, dressing, transfers, and management of bowel and bladder incontinence. His comprehensive care plan included monitoring labs and urinary output, reporting significant changes to the MD, and following physician orders to ensure necessary care and services. On the date in question, nursing notes documented that a urine sample was collected using an in-and-out catheter with sterile technique, and that 1000 mL of tea-colored urine with sediment and odor was obtained. The same note reflected that a 16 French catheter with a 10 mL balloon was inserted at that time, and a later note documented 400 mL of amber urine with mucus draining from the Foley catheter. Review of the physician orders for the relevant months showed there were no orders for either an in-and-out catheter or a Foley catheter for this resident. Another nursing note from earlier that afternoon showed that the on-call physician had been contacted and had given new orders only to collect a urinalysis (U/A). In an interview, the RN who performed the procedures stated that the resident needed an in-and-out catheter to obtain urine for the U/A, that the resident was having difficulty with the in-and-out catheter, and that she then inserted a Foley catheter. She acknowledged she did not contact the physician for either the in-and-out catheter or the Foley catheter and stated that facility protocol required contacting the physician anytime a resident might need a catheter, IV, or any new treatment. The ADON confirmed that the expectation was for the nurse to obtain physician orders for any catheter and that there was no documentation indicating the physician had been contacted about the need for catheters. The facility’s policy on physician orders stated that physician orders are essential for the comprehensive care of residents and to ensure they receive necessary care and services.
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