Failure to Provide Skin Protection and Follow Compression Sleeve Orders
Penalty
Summary
The facility failed to conduct accurate and ongoing assessments for bruising and did not implement appropriate skin protection interventions for a resident on anticoagulant therapy. The resident, who was cognitively intact and independent with mobility, had a history of easy bruising related to apixaban use. Despite documentation of ongoing bruising and the resident expressing interest in trying skin protection sleeves, staff did not offer or provide these interventions. Interviews with nursing staff confirmed that no skin protectant or derma sleeves were care planned or provided, and the resident had not previously been offered these items, contrary to facility expectations for residents on anticoagulants. Additionally, the facility failed to follow physician orders for the application of ankle compression sleeves for another resident with edema. The resident, who had no cognitive impairment and was being treated with diuretics for edema, had an active order for bilateral ankle compression sleeves to be applied in the morning and removed at bedtime. Observations and interviews revealed that the resident was not wearing the prescribed compression sleeves on multiple occasions, and staff confirmed that the task was not included in the care plan or Kardex. Documentation in the treatment administration record indicated the sleeves were applied and removed, but direct observation and resident statements contradicted this. Both deficiencies were further compounded by the lack of specific interventions in the care plans for the identified conditions and the absence of relevant facility policies for anticoagulant use/monitoring and edema management. The facility's skin management program referenced preventive interventions but did not address the specific needs of residents with anticoagulant therapy or edema, and requested policies were not provided.