Failure to Assess and Monitor Bruises, Constipation, Edema, and Medication Administration Parameters
Penalty
Summary
The facility failed to provide appropriate treatment and care according to physician orders, resident preferences, and goals for multiple residents. For two residents on anticoagulant therapy, staff did not assess or monitor bruises as required by care plans and facility policy. In one case, a resident with a history of diabetes, sepsis, and heart disease was observed with reddish/purple discoloration on the forearm, but there was no documentation or assessment of this new skin condition. Another resident was observed with multiple bruises on the hands and arm, attributed to lab draws, but again, there was no documentation or monitoring of these bruises as required. For a resident receiving opioid pain medication following a surgical amputation, staff failed to adequately monitor and document signs and symptoms of constipation. The resident experienced several days without a bowel movement, followed by vomiting and abdominal pain, which led to further medical intervention. Documentation was incomplete, and the facility's bowel protocol was not followed, as there was a lack of timely assessment and intervention for constipation related to opioid use. Additionally, the facility did not properly monitor or assess edema for a resident with end stage renal disease and hypertension. The use of a compression glove for hand swelling was not clearly documented, and there was no care plan or intervention specific to the right hand edema. The documentation on the use of the compression glove was unclear, with no explanation of the symbols used to indicate skin assessment findings. Furthermore, for another resident with cardiovascular conditions, medications intended to be held for low blood pressure were administered outside of the prescribed parameters on multiple occasions, contrary to physician orders.