Failure to Provide Offloading Device and Adhere to Antihypertensive Parameters
Penalty
Summary
The facility failed to provide appropriate care and services for two residents. For one resident with a surgical wound, documentation indicated the need for offloading the affected area using standard facility practices, such as a foam boot, to minimize pressure. Despite the resident's report of unintentionally rolling onto the wound during sleep and the nurse practitioner's verbal acknowledgment of a solution, no foam boot was provided, and staff were unaware of any such device being ordered or available. Observations confirmed the absence of the offloading device in the resident's room, and the wound care nurse stated that no order for the boot had been entered. For another resident with a history of orthostatic hypotension and multiple falls, the physician's order specified that Midodrine should be held if the resident's blood pressure exceeded 130. However, medication administration records showed that the antihypertensive was given on two occasions when the resident's blood pressure was above the prescribed threshold. The DON confirmed that the medication should have been withheld according to the order.