Failure to Develop Comprehensive Care Plan for Resident's Skin Condition
Penalty
Summary
The facility failed to develop and implement a comprehensive care plan for a resident with ongoing skin issues, specifically Prurigo Nodularis, as identified during a recertification survey. The resident, who was admitted with diagnoses including Chronic Liver Disease and skin conditions, reported itchy skin since admission and noted that the facility was supposed to provide cream but did not. A dermatology consult confirmed the presence of erythematous papules and diagnosed the resident with Prurigo Nodularis, yet no care plan addressing these skin issues was created or implemented. Interviews with facility staff revealed a lack of coordination and responsibility in addressing the resident's skin condition. The Medical Doctor acknowledged the resident's chronic liver condition and its potential link to itchiness but did not renew the Cortisone cream due to concerns about skin thinning and the resident's intermittent complaints. The Director of Nursing indicated that the Minimum Data Set Coordinator and nurse supervisors were responsible for care plan initiation and revision, yet this was not done for the resident's skin condition, leading to the deficiency.
Plan Of Correction
Plan of Correction: Approved January 2, 2025 Immediate Correction 1) On 12/30/24, An MD assessment was completed on Resident #111 who addressed the itchy skin condition by giving the resident a cream. 2) On 12/10/24, A comprehensive care plan was developed and implemented to address Resident #111’s ongoing skin condition. 3) On 12/26/24, Education was completed for the staff responsible for initiating clinical care plans. Identification of Others 1) A facility-wide audit tool will be developed to identify all residents with skin conditions or similar complaints who may not have a comprehensive care plan in place. 2) All identified residents will have their care plans reviewed, developed, or updated to address their individual needs. Systemic Changes 1) The facility policy on Comprehensive Care Planning was reviewed and revised by Facility Administrator to include specific guidelines for the development and implementation of care plans addressing chronic conditions, including skin conditions. 2) Clear timelines for initiating care plans upon admission and updating them quarterly or as conditions change were added to the policy. 3) Minimum Data Set (MDS) Coordinator, RN's and LPN's were re-educated on: - The process of developing, implementing, and updating comprehensive care plans. - Identifying resident needs through assessments, observations, and interdisciplinary collaboration. - Incorporating physician recommendations, specialist input, and resident preferences into care plans. 4) A checklist audit tool was introduced to ensure care plans address all identified medical, nursing, psychosocial, and other resident needs. 5) The care plan includes measurable objectives and specific interventions, such as: - Monitoring the skin condition for changes or flare-ups. - Ensuring availability and application of prescribed topical creams or other dermatologic treatments as needed. - Coordinating with dermatology for follow-up consultations and recommendations. - Educating staff on proper skin care techniques and resident preferences. Quality Assurance (QA) 1) The Director of Nursing (DON) or designee will review care plans weekly to ensure all identified conditions are addressed in comprehensive care plans. 2) Random audits of care plans will continue quarterly for one year, ensuring compliance with federal regulations and timely updates to care plans as resident needs change. 3) Audits will be completed by the Director of Nursing weekly x 4 weeks; monthly x 3 months; and quarterly for x 1 year. Any negative findings will be addressed immediately. 4) Findings will be brought to the QAPI quarterly meeting for tracking of facility compliance. Person Responsible for this Ftag: 1) The Director of Nursing.