Unauthorized Catheter Insertion Without Physician Orders
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and physician orders. 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 incontinence of bowel and bladder. His comprehensive care plan identified risks related to chronic kidney disease, potential renal failure, fluid volume deficit, and the need to monitor and report abnormalities in urinary output and other symptoms to the physician. On the identified date, nursing documentation showed that a urine specimen was collected using an in-and-out catheter, during which 1000 mL of tea-colored urine with sediment and odor was obtained, and a 16 French catheter with a 10 mL balloon was inserted. Later that same day, nurses’ notes documented 400 mL of amber urine with mucus draining from a Foley catheter. The physician orders for the months reviewed did not contain any order for an in-and-out catheter or for a Foley catheter for this resident. Earlier that afternoon, the on-call physician had been contacted and had given an order only to collect a urinalysis. In interview, the RN who performed the catheterization stated the resident needed an in-and-out catheter to obtain urine for the urinalysis, 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 any time 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 both types of catheters 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 to ensure residents receive necessary care and services, and the surveyors found that no such orders existed for the catheterization performed on this resident.
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