Failure to Provide Ordered Catheter Care, Output Monitoring, and Timely Urine Testing
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered catheter care, monitoring, and timely diagnostic testing for a resident with complex urologic conditions. The resident had spina bifida with hydrocephalus, paraplegia, neuromuscular dysfunction of the bladder, and a history of UTI, and was admitted with an indwelling urinary catheter related to neurogenic bladder. The care plan and physician orders required monitoring and documenting catheter output on day and night shifts, and monitoring for signs and symptoms of UTI. Review of the Treatment Administration Records showed multiple days across December, January, and February when catheter output was not documented on both day and night shifts. The resident reported that on some days the catheter bag was not emptied at all and that she had to ask staff to empty it. Staff interviews revealed that NAs sometimes emptied catheter bags and reported amounts to nurses, while a nurse and the PA both stated they had observed full catheter bags with urine backflow toward the resident. The facility also failed to provide appropriate catheter hygiene and perineal care as ordered. A physician order directed cleansing with soap and water every day and night shift. During an observation, dry brown stool was seen on the resident’s lower buttocks and on the urinary catheter from the meatus to the middle of the catheter. An NA was observed applying an adult brief over the area without cleaning the stool from the catheter. In a subsequent interview, the NA acknowledged that the stool had been present before she applied the brief and stated it should have been removed before the brief was applied, noting that the resident was not on her assignment. The PA stated that if stool remained on a urinary catheter and was not cleaned properly, it could cause a UTI. The DON and ADON both stated they would expect catheter care to be provided when needed, regardless of staff assignment. Additionally, the facility failed to obtain ordered urine analysis and culture and sensitivity specimens within the ordered timeframe. A physician ordered a UA and C&S once daily for three days, but the TAR showed no documentation that these specimens were obtained on the ordered dates. A later UA and C&S obtained on a subsequent date showed the resident was positive for E. coli. The PA reported there had been ongoing issues with specimens not being obtained, requiring him to reorder UAs multiple times and sometimes change antibiotics after results were finally received. Nursing leadership stated they expected licensed staff to collect specimens when ordered and to notify the provider if a specimen could not be obtained, and the Administrator stated that if a specimen could not be obtained, the PA should be called and the specimen should be obtained within 24 hours.
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