Failure to Monitor Post-Contrast Renal Risk and Inadequate Wound Assessment
Penalty
Summary
The facility failed to comprehensively assess and monitor a resident following a CT scan with contrast dye, despite the resident's significant risk factors for acute renal failure. The resident had multiple comorbidities, including hemiplegia, heart failure, renal failure, diabetes, and morbid obesity, and was dependent on staff for all activities of daily living. Although there was a physician order for the resident to drink a specified amount of water daily before the dye study to protect kidney function, the order was transcribed incorrectly as 'encourage' rather than 'drink,' and there was no documentation or monitoring of the resident's actual fluid intake. Additionally, staff did not monitor or document urine output, and there was no evidence that the physician was notified of the resident's elevated temperature or significant weight gain, both of which could indicate fluid overload or infection. Staff interviews revealed a lack of awareness and communication regarding the need to monitor fluid intake and the risks associated with the CT scan with contrast. Nursing assistants and LPNs were not informed about the fluid order or the importance of monitoring intake and output, and there was confusion about the resident's care needs. The director of nursing acknowledged the error in transcribing the order and the lack of monitoring, and also noted that changes in the resident's condition were not documented in a timely manner. The resident's condition deteriorated over several days, with symptoms including wheezing, decreased appetite, and minimal fluid intake, but appropriate assessments and notifications were delayed. Ultimately, the resident was transferred to the hospital with severe acute kidney injury and died due to acute and chronic kidney failure. The facility also failed to comprehensively assess, monitor, and treat wounds for another resident with non-pressure skin concerns. Documentation showed inconsistent and incomplete wound assessments, with missing measurements and lack of weekly evaluations as required by the care plan and facility policy. There was confusion among staff regarding the nature and management of the wound, and the physician was not promptly informed of the wound's location and severity. The wound persisted for several months, with ongoing drainage and changes in treatment orders, but without consistent documentation or communication. The facility's policies required weekly comprehensive wound assessments and timely physician notification for changes, but these were not consistently followed.