§483.25(e) Incontinence. §483.25(e)(1) The facility must ensure that resident who is continent of bladder and bowel on admission receives services and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain.
§483.25(e)(2)For a resident with urinary incontinence, based on the resident's comprehensive assessment, the facility must ensure that- (i) A resident who enters the facility without an indwelling catheter is not catheterized unless the resident's clinical condition demonstrates that catheterization was necessary; (ii) A resident who enters the facility with an indwelling catheter or subsequently receives one is assessed for removal of the catheter as soon as possible unless the resident's clinical condition demonstrates that catheterization is necessary; and (iii) A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible.
§483.25(e)(3) For a resident with fecal incontinence, based on the resident's comprehensive assessment, the facility must ensure that a resident who is incontinent of bowel receives appropriate treatment and services to restore as much normal bowel function as possible.
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Observations:
Based on clinical record review and staff interview, it was determined that the facility failed to ensure physician orders were followed for catheter care for one of two residents reviewed for catheters (Resident 75).
Findings include:
Review of Resident 75's clinical record revealed diagnoses that included obstructive and reflux uropathy (a blockage in the urinary tract that causes trouble urinating), benign prostatic hyperplasia (an enlarged prostate), and chronic kidney disease (a condition characterized by a gradual loss of kidney function).
Review of Resident 75's physician orders revealed an order for "Catheter Protocol Foley Check: Code 1=Patent, output good, No sediment; 2=Low output; 3=sediment- Every shift", with a start date of December 14, 2023, and an end date of December 28, 2023.
Review of Resident 75's TAR (Treatment Administration Record - documentation for treatment administered or monitored) failed to reveal documentation to indicate Resident 75's aforementioned catheter order was completed on December 21, 2023, day shift; and December 23 and 26, 2023, night shift.
Review of Resident 75's physician orders revealed an order for "Catheter Foley tubing Stabilization Adhesive Anchor Type - Catheter Care - Every shift. Anchor site check, change anchor as needed. Code 0 = Skin intact, 1 = Red, 2 = Pink, 3 = Open area, once daily", with a start date of December 14, 2023, and an end date of December 18, 2023.
Review of Resident 75's TAR failed to reveal documentation to indicate Resident 75's aforementioned catheter order was completed for the duration of the order.
Review of Resident 75's physician orders revealed an order for "Catheter Graduated Container Change Type - Catheter Care - Once daily (weekly on Saturday)".
Review of Resident 75's TAR failed to reveal documentation to indicate Resident 75's aforementioned catheter order was completed on January 16, 2023.
Review of Resident 75's physician orders revealed an order for "Catheter Protocol Foley Check: Code 1=Patent, output good, No sediment; 2=Low output; 3=sediment- Every shift", with a start date of December 28, 2023.
Review of Resident 75's TAR failed to reveal documentation to indicate Resident 75's aforementioned catheter order was completed on January 12, 2024, day shift; January 8, 12, and 14, 2024, evening shift; and December 30, 2023, and January 9, 2024, night shift.
Review of Resident 75's physician orders revealed an order for "Catheter Foley tubing Stabilization Adhesive Anchor Type - Catheter Care - Every shift. Anchor site check, change anchor as needed. Code 0 = Skin intact, 1 = Red, 2 = Pink, 3 = Open area, every shift", with a start date of December 18, 2023.
Review of Resident 75's TAR failed to reveal documentation to indicate Resident 75's aforementioned catheter order was completed on December 21, 2023, and January 12, 2024, day shift; December 18, 2023, and January 8, 12, 14, 2024, evening shift; and December 18, 23, 26, and 30, 2023, and January 9, 2024, night shift.
Interview with the Nursing Home Administrator on January 18, 2024, at 11:40 AM, revealed she would expect physician orders to be followed and documented as completed.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services
| | Plan of Correction - To be completed: 03/05/2024
1. R 75's foley catheter has been evaluated for patency, output and proper securement. Resident has experienced no ill effects from missing documentation. 2. Residents with foley catheters will have their physician orders and documentation over last 7 days reviewed for completeness. Evaluations will be completed as necessary. 3. Licensed staff will be re-educated on completion and documentation of physician orders by the Director of Nursing or designee. 4. Random audits of residents with foley catheters will be completed weekly x 12 weeks by Director of Nursing or designee to validate physician ordered catheter orders are completed as ordered. The DON/designee will review the results of the audits to identify/track trends or patterns and present to the Quality Assurance Performance Improvement (QAPI) committee for further review and/or recommendation.
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