Failure to Ensure Nurse Competency in Admission Assessment and Medication Management
Penalty
Summary
The facility failed to ensure that a registered nurse possessed the necessary competencies and skills to properly assess a newly admitted resident, resulting in the resident receiving unnecessary medication and experiencing a delay in wound treatment. Upon admission, the nurse transcribed an order for Seroquel at a higher dose than what was indicated in the hospital discharge records and entered a diagnosis of bipolar disorder that was not present in the resident's medical history. The medical doctor later confirmed that the resident did not have bipolar disorder and that the higher dose of Seroquel was not appropriate, as the original hospital order was for a lower dose and for a different indication. Additionally, the admitting nurse did not identify or document a sacrococcygeal pressure ulcer during the initial assessment, despite later findings of a significant unstageable pressure ulcer measuring 21.1 cm. The wound was not assessed by the wound care nurse until several days after admission, and treatment was not initiated until three days post-admission. The delay in assessment and treatment was corroborated by interviews with the treatment nurse and assistant director of nursing, who acknowledged that the skin assessment should have been completed immediately upon admission to prevent further injury. Family members expressed concern about the resident's increased sleepiness and lack of progress in therapy, which they attributed to overmedication. The facility's policies and procedures require registered nurses to accurately assess new admissions, follow physician orders, and document the general condition of residents upon admission, including skin condition. These requirements were not met in this case, leading to unnecessary medication administration and delayed wound care for the resident.