Deficiencies in Skin Care and Medication Administration
Penalty
Summary
The facility failed to implement a resident's care plan for preventative skin care treatment against pressure ulcers from January to June 2024. The care plan included routine and as-needed skin care, which was not consistently documented in the Activities of Daily Living (ADL) log. The Treatment Administration Record (TAR) did not include an order for preventative skin care until June 25, 2024. The Director of Nursing (DON) confirmed that the preventative skin treatment was not reflected in the January 2024 log, indicating a lapse in the documentation and execution of the care plan. Additionally, the facility did not provide prescribed treatment with Z-guard paste in a timely and consistent manner. A skin evaluation on February 10, 2024, revealed a new stage 2 pressure ulcer on the resident's buttocks, but subsequent evaluations did not document any skin issues until June 23, 2024, when a nurse noted a small opening in the sacral area. The Nurse Practitioner ordered Z-guard paste to be applied twice daily, but the TAR showed missed administrations on several dates in June and July 2024. The facility also failed to administer Clonazepam as scheduled, with delays in administration noted on multiple occasions in June and July 2024. The DON acknowledged the late administration of medications, attributing it to staffing shortages. The facility's policy requires medication orders to be documented in the resident's medical record, but the report indicates inconsistencies in following this protocol, contributing to the deficiencies observed.
Plan Of Correction
1. Corrective Action of Areas Affected: Resident #76 is NJ Ex Order 26.461 in the facility. 2. Other Areas Affected: All residents have the potential to be affected by this practice. 3. Systemic Changes to Prevent Future Occurrences: A) DON/Designee has re-educated the nursing staff on the importance of adhering to care plans, timely receiving and medication administration, and the prevention and treatment of pressure ulcers. Medication pass observations have been conducted for licensed staff. An initial audit has been completed by the DON/Designee of admissions in the last 30 days to verify care plans are current, accurate, and reflect the resident's individual needs regarding skin care and pressure ulcer prevention. B) DON/Designee has re-educated nursing staff on proper medication administration procedures, including medication timing and documentation. Residents with new orders for medications for the past 5 days have been reviewed during clinical meetings to verify medication was received and administered timely. 4. Monitoring of Corrective Action: A) DON/Designee to audit 5 care plans per week x 4 weeks then monthly x 2 for accurate reflection of residents' skin care and pressure ulcer prevention needs. B) DON/Designee to audit 5 resident medication administration records per week x 4 weeks then monthly x 2 to verify timely and consistent administration of medications. Results of all audits to be reviewed monthly at the facility's Quality Assurance Improvement Meetings.