Failure to Follow Physician Orders for Compression Stockings and Leg Wraps
Penalty
Summary
A deficiency occurred when the facility failed to follow physician orders for the application of compression stockings or leg wraps for a resident with a diagnosis of hypertension and edema. The resident had physician orders to apply compression stockings daily before getting out of bed and to wrap both legs from toes to knees daily for edema, as well as care plan interventions to apply compression stockings and notify the physician if edema increased. Despite these orders, multiple observations over several days showed the resident sitting with legs elevated and visible edema, but without compression stockings or wraps applied. The resident reported that their legs were hurting due to swelling and stated that it had been weeks since anyone had applied the stockings or wraps, expressing a desire for them to be used. Interviews with staff revealed confusion and lack of awareness regarding the orders. A CNA reported last applying the stockings nearly two weeks prior and did not document the resident's request for removal. Another CNA and a restorative CNA stated they had not applied or offered the stockings. LPNs were unaware of the orders, as they were not present on the Treatment Administration Record (TAR) or Medication Administration Record (MAR), and believed it was the responsibility of the treatment nurse. The Director of Nursing acknowledged the orders were overlooked and entered incorrectly, while the Medical Director confirmed the stockings or wraps should have been applied or offered daily, with refusals documented and education provided.