Failure to Apply Prescribed Ace Wraps for Edema Management
Penalty
Summary
The facility failed to provide appropriate treatment and care for a resident with edema, as evidenced by the lack of application of ace wraps to the resident's lower extremities. The resident, who had diagnoses including congestive heart failure, atrial fibrillation, and edema, was observed multiple times without the prescribed ace wraps, despite having orders for their use to manage edema. The resident's care plan also included instructions to encourage the use of ace wraps and document any refusals, yet there was no documentation of the ace wraps being applied or any refusals recorded for the month of February. Interviews with facility staff revealed that the resident occasionally refused care, particularly from male caregivers, but there was no documented evidence of such refusals regarding the ace wraps. The Director of Nursing stated that refusals should be documented by nursing staff if a resident continues to refuse care after re-approach attempts. The lack of documentation and adherence to the care plan and physician's orders resulted in the resident not receiving the necessary treatment for their condition, as observed during the survey.
Plan Of Correction
Plan of Correction: Approved March 19, 2025 F684 Corrective Action- To assure that Residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan and the residents’ choices. 1. On 2/27/25, the provider reviewed and revised resident #51’s order for ace wraps, requiring progress notes for all refusals. On 3/17/25, resident #51’s care plan was reviewed and remains appropriate in regards to ace wraps. 2. All residents who have orders for ace wraps have the potential to be affected by this practice. A list of all residents requiring ace wraps will be created and audited to ensure that ace wraps are applied as directed and documented appropriately. 3. To ensure this practice does not reoccur, the facility policy on “Medication/Treatment administration: Documentation” will be reviewed and revised if necessary. All licensed nursing staff (RN, LPN) will be re-educated on this policy. The Director of Nursing/designee will oversee in-services for all licensed nursing staff. 4. To prevent further deficiency in this practice, the Director of Nursing/designee will perform 10 audits per month for 3 months, and then as needed based on the audit findings. Audits will verify ace wraps are applied as ordered, and that all refusals are documented. The Director of Nursing will monitor this process and will review the results monthly at QAPI meetings. If continued improvement is required, the committee may make further recommendations. The Director of nursing will assume overall responsibility for correction of F684.