§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.
Based on observations, review of clinical records and staff interview, it was determined that the facility failed to discontinue the use of a catheter as the physician ordered for one of 19 residents (Resident R356).
Resident R356's clinical record revealed an admission date of 2/15/20, with diagnoses that included Alzheimer's disease, seizures, high blood pressure and heart problems.
The "Nursing Admission Screening/History" record revealed that Resident R356 was admitted with a catheter and to have bladder training and to discontinue the catheter on 2/17/20, written by Registered Nurse Employee E2.
The physician order, dated 2/15/20, revealed an order for "bladder training, Foley cath (catheter inserted into the bladder to facilitate urine drainage) clamp times 3 hours then unclamp times one hour until 2/17/20, then discontinue Foley cath/bag."
Observation on 2/19/20, at 1:40 p. m. revealed Resident R356 seated near the nurses station with a Foley catheter, draining urine into a catheter bag.
During an interview on 2/19/20, at 1:47 p.m. Registered Nurse Employee E3 confirmed that Resident R356 was still using the catheter and it had not been discontinued as the physician ordered.
28 PA Code 211.12(d)(1)(3)(5) Nursing services
| ||Plan of Correction - To be completed: 03/10/2020|
1. Resident R356's physician was notified 2/18/20 and orders to bladder train and remove catheter on 2/21/20 given.
2. The Director of Nursing will review current residents with catheters to ensure physician orders are being followed.
3. The licensed nursing staff will be re-educated by the Director of Nursing/designee on following physician orders with emphasis on catheter orders.
4. The Director of Nursing/designee will audit physician orders daily for two weeks, weekly for 2 weeks and monthly for three months to ensure physician orders are being followed. Outcomes will be reported to the Quality Assurance Performance Improvement Committee for review and recommendations.