Failure to Assess and Treat Impaired Skin Integrity
Penalty
Summary
The facility failed to comprehensively assess and treat impaired skin integrity for a resident with acute dermatitis. The resident, who had diagnoses including type two diabetes and obesity, was admitted with a history of frequent incontinence and required extensive assistance with personal hygiene and toileting. Hospital discharge orders included specific topical treatments and interventions for skin care, but review of the medication administration record showed no indication that these treatments were applied. The initial skin assessment did not identify issues, but subsequent progress notes and observations revealed persistent redness and moisture under abdominal folds and in the groin area. During care observations, a nursing assistant noted significant redness and soreness in the resident's abdominal fold and groin but did not report these findings to the nurse. Instead, the nursing assistant independently applied antifungal cream without notifying licensed staff or ensuring physician orders were followed. The infection preventionist later confirmed the presence of red and moist skin areas and stated that the issue should have been reported to the nurse and physician for appropriate intervention. The resident reported a history of similar skin issues and described more frequent hygiene interventions at a previous facility, which were not provided at the current facility due to the resident's condition. Interviews with nursing staff and the director of nursing revealed a lack of documentation regarding the skin condition and a reliance on nursing assistants to report new skin issues. The director of nursing acknowledged that it was outside the scope of practice for a nursing assistant to choose and apply treatment products without nurse or physician involvement. The facility's wound care procedure required verification of physician orders and documentation of wound care, which was not followed in this case.