Deficiency in Nursing Practice and Medical Appointment Scheduling
Penalty
Summary
The deficiency involves improper handling and documentation of medical procedures and orders for residents in the facility. Staff D, an LPN, highlighted a failure to adhere to standard nursing practices, specifically regarding the flushing of feeding tubes. It was noted that a syringe, which should have been used for flushing, was found dry and unused in a Styrofoam cup, indicating that the procedure may not have been performed as required. This was corroborated by Staff F, another LPN, who confirmed that the standard practice is to flush the tube before and after use. The Director of Nursing attempted to address the issue by educating the involved nurse, who claimed to have flushed the tube, but the physical evidence suggested otherwise. Additionally, there was a failure in scheduling and documenting necessary medical appointments for a resident who had a new medical device placed prior to their arrival at the facility. Staff E, an RN, and Staff D, an LPN, both confirmed that there was no record of the resident being scheduled to see a specialist, despite an order being present in the resident's chart. This oversight was attributed to a breakdown in communication and procedure, as the medical records clerk was not informed of the need to schedule the appointment, and the order was not followed up on in a timely manner.
Plan Of Correction
4: How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put into place. A. The Director of Nursing/Designee will audit daily the Medication Administration Record to ensure no medications were missed the day prior and if any were missed that appropriate interventions were done. This audit will continue weekly for four weeks then monthly for one quarter. B. The Director of Nursing/Designee will do random audits of licensed nurses and feeding residents to ensure tube placement is checked prior to administration of the medication. This audit will continue weekly for four weeks then monthly for one quarter. C. The Director of Nursing/Designee will do random audits of licensed nurses during medication administration to residents to ensure an accurate scale is obtained and documented. This audit will continue weekly for four weeks then monthly for one quarter. D. The Director of Nursing/Designee will submit a report of the findings to the Quality Assessment, Assurance and Compliance Committee monthly for one quarter.