Failure to Follow Physician's Orders for Compression Device Application
Penalty
Summary
A deficiency was identified when a facility failed to follow physician's orders for a resident with hemiplegia, hyperlipidemia, and hypertension. The physician had ordered an edema glove to be applied to the resident's left hand to reduce swelling. However, review of the clinical record and task documentation showed a task to apply a Geri sleeve to the left upper extremity in the morning and remove it at bedtime, but there was no evidence that either the glove or sleeve was consistently applied as ordered. Multiple observations over several days revealed that the resident was repeatedly seen without the prescribed glove or sleeve on their left hand or arm, both while in bed and in a wheelchair. During an interview, an LPN confirmed that the resident did not have the glove or sleeve on and acknowledged that, according to the physician's orders, the resident should have had it applied. This failure to follow physician's orders constituted a deficiency under the cited regulations.
Plan Of Correction
R197's sleeve/glove were placed on resident upon notification. Initial audit was completed for residents with geri sleeve or edema glove orders. All were available and being worn per physician orders. Geri sleeves/edema gloves were documented by the nursing assistant in Point Click Care point of care. Geri sleeves/edema gloves will be added to the Licensed Practical Nurse treatment administration record to ensure they are being worn per physician order. All nursing staff will be educated on following the physician orders. Certified Nursing Assistant will be educated on the importance of applying geri sleeves/edema gloves as ordered. Ward clerks will be educated on adding these orders to the Licensed Practical Nurse treatment administration record. All Licensed Practical Nurses will be educated on ensuring residents with orders for sleeves/gloves are wearing as ordered and documenting in the treatment administration record. A daily audit will be conducted by the Registered Nurse Supervisor on each shift to ensure all geri sleeves/edema gloves are on per orders and documented in the resident record. Results of these audits will be reviewed at the Quality Assurance Committee monthly for review until audits meet 100% compliance for three consecutive quarters. The Director of Nursing/designee will be responsible for compliance. Completion Date: 7/31/25