Failure to Monitor Bruising in Resident on Anticoagulant
Penalty
Summary
A resident with diagnoses including end stage renal disease, anemia, and heart failure was admitted to the facility and was receiving Apixaban, an anticoagulant, as ordered by her physician. The resident's care plan identified her as being at risk for hematological alterations due to anemia and anticoagulant side effects, with interventions to administer medications as ordered and observe for side effects such as bruising. Despite these interventions, observations revealed maroon, gray-brown, and yellow bruising on the resident's bilateral forearms and lower right extremity. The assigned RN was unaware of the bruising until it was pointed out during the survey, despite the resident being on anticoagulant therapy. Further review and interviews with the DON and wound nurse confirmed there was no documented evidence of monitoring the resident's bruising in the medical record. This lack of monitoring and documentation for bruising in a resident on anticoagulant medication constituted the deficiency identified during the survey.