Failure to Apply Compression Stockings as Ordered for Residents with Edema
Penalty
Summary
The facility failed to ensure that two residents received treatment and care in accordance with physician orders and professional standards of practice. Both residents had physician orders for compression stockings to be applied in the morning and removed in the evening to address edema. Observations on multiple occasions revealed that neither resident was wearing compression stockings, and both exhibited signs of edema in their lower extremities. One resident, with severely impaired cognition, was observed without compression stockings and reported that staff only put regular socks on him. The other resident, who was cognitively intact, also reported that staff did not apply the compression stockings and only applied cream to his legs. Record reviews showed that the care plan for one resident did not address edema or the use of compression stockings, despite the physician's order. Interviews with staff revealed a lack of awareness and responsibility regarding the application of compression stockings. A CNA assigned to both residents was unaware of the order, believing it was the nurse's responsibility. The nurse assigned to the residents acknowledged the orders but cited distractions and lack of stockings in the residents' rooms as reasons for not applying them. The nurse also admitted to not having received in-service training on compression stockings. Further interviews with facility leadership confirmed that nurses were responsible for following physician orders and documenting the application or refusal of compression stockings. The ADON and interim DON both stated that failure to apply the stockings could worsen the residents' edema. It was also noted that there had been no in-service training on compression stockings for staff, and the facility's policy on antiembolism hose did not specifically address adherence to physician orders.