Failure to Maintain Appropriate Catheter Orders, Assessment, and Monitoring
Penalty
Summary
The deficiency involves the facility’s failure to ensure appropriate assessment, orders, and care for residents with urinary catheters. For one resident with a suprapubic catheter, the admission assessment did not document the presence of a catheter, and physician orders lacked a specific order for the catheter type and supporting diagnosis, despite orders for suprapubic catheter care, catheter changes as needed, and monitoring of output each shift. The treatment administration record showed ongoing suprapubic catheter care, but the comprehensive care plan contained no focus or interventions for catheter care, and the catheter was not included on the baseline or comprehensive care plan. The resident had severe cognitive impairment, obstructive uropathy, and non-Alzheimer dementia, and was known by staff and the resident representative to have a catheter upon admission and throughout the stay. Staff, including an LPN and the DON, acknowledged that there was no physician order specifying the catheter type, even though they stated such an order was required to guide care. For another resident with an indwelling catheter, surveyors observed the catheter tubing filled with a thick off-white substance extending from the resident’s body into the drainage bag. The physician order directed that the catheter be changed as needed or when clinically indicated. The resident had severe cognitive impairment with a BIMS score of 0, diagnoses of cerebral palsy and traumatic brain injury, and was dependent on staff for all needs. An LPN stated that catheters should be changed if there were signs of infection, but noted the resident did not have a fever and described the thick off-white substance as sometimes normal. The DON described the catheter tubing as stained and very cloudy with sediment and was unsure if this appearance was normal for the resident, and also noted the catheter tubing was not secured to the resident’s leg, despite acknowledging it was advised to secure the catheter to prevent pulling against the bladder wall.
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