HospitalInspections.org

Based on policy review, document review, medical record review, and interview, nursing staff must adhere to policies and procedures of the hospital and nursing administration must provide adequate supervision and evaluation of nursing personnel.

1.Nursing staff did not obtain an order for the insertion of a urinary foley catheter (tube that goes in the bladder to drain urine) for two of four medical records reviewed (Patients #22 and #23).
2.The hospital does not have a facility protocol for the irrigation of a urinary (Foley) catheter.

Findings #1:

Review on 09/06/24 of the policy "Prevention of Catheter-Associated Urinary Tract Infections - Adult/ Pediatric," last revised 01/31/22 revealed "urinary (foley) catheters (a tube used to drain urine from the bladder) should be inserted when necessary and left in place only for as long as needed. A provider's order and document reason for use should be documented in the medical record."

Review on 09/06/24 of the medical record for Patient #22 dated 09/02/24 at 03:00 PM revealed Patient #22 arrived at the emergency department via ambulance with a possible drug overdose and was admitted to the intensive care unit. At 03:00 PM, Staff (BB) Registered Nurse, documented a urinary (foley) catheter was inserted. There was no evidence of a physician order for the insertion of the urinary (foley) catheter in the medical record.

Review on 09/06/24 of the medical record for Patient #23 dated 09/04/24 at 07:45 PM revealed Patient #23 arrived at the emergency department via ambulance with bloody vomit and alcohol abuse disorder and was admitted to the intensive care unit. On 09/05/24 at 04:00 AM Staff (GG), Registered Nurse, documented a urinary (foley) catheter was inserted to monitor urinary output. There was no evidence of a physician order for the insertion of the urinary (foley) catheter in the medical record.

Interview on 09/06/24 at 12:00 PM with Staff (A), Chief Quality Officer, and on 09/06/24 at 02:00 PM with Staff (F), Director of Critical Care, verified Patient #22 and Patient #23 did not have a physician order for the insertion of a urinary foley catheter.

Findings #2:

Review on 09/06/24 of facility documents revealed no evidence of a policy, guidance document, and/or staff education for the irrigation (flushing) of a urinary foley catheter.

Review on 09/06/24 of the "Registered Professional Nurse Essential Competency Assessment Tool," last revised 11/2019, did not include a competency (ability to perform) for the irrigation (flushing) of a urinary foley catheter.

Interview on 09/05/24 at 02:45 PM with Staff (P), Registered Nurse, revealed if a patient's urinary foley catheter needed to be manually irrigated, they would obtain a sterile irrigation kit and follow the providers order regarding what solution and how much of the solution was to be used. After the irrigation was completed, all supplies would be discarded. New supplies would be used if manual irrigation of the urinary foley catheter was required again.

Interview on 09/05/24 at 03:20 PM with Staff (Q), Registered Nurse, revealed they use sterile fluid each time the irrigation of a urinary foley catheter is completed. The syringe is reused, placed in the original package, and stored in the patient's room on the corner wall shelving. The syringe is replaced every 24 hours by the night shift registered nurse.

Interview on 09/06/24 at 10:10 AM with Staff (S), Registered Nurse, revealed they would perform manual urinary foley catheter irrigation with an order from a provider. Staff (S) would open the supplies at the bedside. The syringe is reused and discarded after each shift. Staff (S) stated the policy for manual irrigation was available, however they were unable to locate the policy on the hospital intranet.

Interview on 09/06/24 at 11:45 AM with Staff (F), Director of Critical Care, revealed the registered nurse initial/annual competency assessment tool does not include irrigation (flushing) of a urinary foley catheter.

Interview on 09/06/24 at 02:00 PM with Staff (A), Chief Quality Officer, revealed there was no policy found for manual/hand irrigation of a urinary foley catheter.