Failure to Obtain Smoking Contract Upon Admission
Penalty
Summary
The facility failed to have a resident who smoked sign the Smoking Contract/Agreement upon admission, which was identified as a deficient practice for one of the three residents reviewed for accidents. The resident, who was admitted with diagnoses including hypertension, anxiety disorder, bipolar disorder, and polyneuropathy, was observed ambulating in the hallway and later in their bedroom. The resident's medical record indicated an intact cognition and current tobacco use, with a comprehensive care plan noting the resident as a smoker. However, the Smoking Contract/Agreement was not signed until several months after admission, and the facility could not provide a smoking contract from the time of admission. Interviews with facility staff, including the Activities Director and the Director of Nursing, revealed that smoking assessments and contracts were supposed to be completed upon admission. The Director of Nursing stated that Smoking Contracts should be completed within 72 hours of admission, but could not confirm when they should be completed other than upon admission. The Licensed Nursing Home Administrator acknowledged that a Smoking Contract should have been completed upon the resident's admission. The facility's Smoking Policy required all residents who smoke to sign a smoking agreement contract upon admission, which was not adhered to in this case.
Plan Of Correction
1. Resident affected by deficient practice: Resident #82 had a NJ Exec Order 26.4b1 completed on [R]. 2. Identifying other residents who could be affected by the deficient practice: Residents who smoke could be affected by this deficient practice. All other residents who smoke were audited for smoking contracts and no further issues were identified. 3. Measures or systemic changes to ensure that the deficiencies will not recur: Smoking policy/process re-education provided to clinical team ([R], Unit Managers, Nursing Supervisors, Licensed Nurses, and the [R] in person by Director of Nursing. The Smoking Policy was reviewed in person with all residents who smoke require a smoking assessment and contract upon admission to the facility. 4. Monitoring the continued effectiveness of the systemic change: The Activities Director/Designee will audit up to five smokers to ensure adherence to smoking policy and procedure have been completed weekly x 4 then monthly x 2. Results of the audit will be reviewed at the Monthly Quality Assurance Meeting and Quarterly over the duration of the audit process to ensure compliance and reassessed for further action.