Failure to Provide Proper Catheter Care and Care Planning for Indwelling Catheter
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate catheter care and related services for a resident with an indwelling urinary catheter, as required by facility policy and the resident’s needs. The resident was cognitively intact, dependent on staff for toileting, and had a diagnosis of neuromuscular dysfunction of the bladder with an indwelling catheter in use. The resident’s care plan addressed monitoring intake and output, catheter tubing kinks, pain or discomfort related to the catheter, and signs and symptoms of urinary tract infections, but did not include any interventions for catheter care. Review of the physician orders for the month showed there were no orders related to catheter care, despite the facility’s written policy requiring catheter care every shift and as needed. During an observed catheter care episode, two CNAs entered the resident’s room, performed hand hygiene, and donned PPE. One CNA removed the resident’s brief while the other cleansed the resident’s inner thighs with a single wet washcloth, folding it over between swipes but not obtaining a new washcloth. The CNA did not remove soiled gloves, perform hand hygiene, or apply new gloves before proceeding. The CNA did not retract the foreskin and cleansed the catheter tubing from the distal end toward the proximal end at the meatus, contrary to the facility policy that required cleansing from the meatus outward. The CNA then provided care to the resident’s backside after bowel incontinence without changing gloves or performing hand hygiene before placing a clean brief under the resident, adjusted the catheter, and hung the catheter bag on the bed. Interviews with the CNA, another CNA, the DON, and the Administrator confirmed that catheter tubing was expected to be cleansed away from the body to prevent infections, which did not occur during the observed care, and that catheter care was not ordered or care-planned for this resident.
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