Failure to Apply Compression Stockings and Incomplete Healthcare Proxy Invocation
Penalty
Summary
The facility failed to provide care and services consistent with professional standards for two residents. For one resident with chronic kidney disease, congestive heart failure, and dementia, there was a physician's order for daily application of compression stockings to both lower extremities. Despite this order, multiple observations over two days showed the resident did not have compression stockings applied, and their lower extremities were swollen and discolored. The Medication Administration Record (MAR) indicated the stockings were applied as ordered, but there was no documentation in the medical record to support that the order was on hold, discontinued, or that the resident refused the intervention. Nursing staff were unclear about their responsibility to check for the application of compression stockings throughout the day, and facility leadership confirmed that documentation should be present if the order was not followed. For another resident with dementia and severe cognitive impairment, the healthcare proxy (HCP) was invoked by a nurse practitioner due to cognitive decline. The HCP invocation form, however, was incomplete; specifically, the sections for the cause and nature of the incapacity were left blank, although the extent and probable duration were documented. The nurse practitioner acknowledged the error and stated that completing the cause and nature is standard practice. Facility leadership also confirmed that the HCP invocation form should be fully completed in accordance with regulatory requirements. These deficiencies were identified through observation, interview, and record review, and were found to be inconsistent with professional standards of quality and regulatory requirements as outlined by the Massachusetts Board of Registration in Nursing and state law regarding healthcare proxy activation.