Failure to Provide Ordered Care for Bowel Management, Edema, and Positioning
Penalty
Summary
The facility failed to provide appropriate treatment and care according to provider orders and residents' needs in several areas, including bowel management, edema management, and positioning. For bowel management, a resident with a history of congestive heart failure had provider orders for as-needed medications to address loose stools. Despite multiple documented episodes of loose stools, there was no evidence that the ordered medications were administered on those occasions. Staff interviews confirmed that the resident should have received the medications as ordered, but this did not occur. In the area of edema management, two residents with conditions such as congestive heart failure, respiratory failure, chronic kidney disease, and dependence on dialysis were not properly monitored or treated for edema. One resident had a care plan requiring daily assessment for edema, but there was no documentation of daily monitoring. Another resident had orders for daily use of compression stockings to manage edema, but observations showed the resident was often not wearing the stockings as ordered, and when worn, they were not properly applied. Additionally, nursing documentation did not accurately reflect the presence of edema, despite visible swelling observed during the survey. For positioning, a resident with significant physical impairments, including hemiplegia and dependence on staff for all care, was observed lying on their back in bed for extended periods across multiple observations. Staff interviews indicated the expectation that the resident should be turned every two hours, but there was no evidence this was occurring. The resident was also on hospice care and unable to consistently voice their needs, further emphasizing the importance of staff adherence to positioning protocols.