Failure to Apply and Document TED Hose Use for Edema Management
Penalty
Summary
Licensed nurses failed to follow physician orders and care plan interventions for a resident who was admitted with multiple diagnoses, including COPD, heart failure, and type II diabetes mellitus. The resident had significant bilateral lower extremity pitting edema, with a care plan and physician order in place for the application of Thrombo-Embolic Deterrent (TED) hose stockings to manage the edema. Despite these orders, staff did not consistently apply the TED hose, and there was no documentation in the medication administration record (MAR) indicating that the TED hose were being used as prescribed. Interviews and observations revealed that the resident was not wearing TED hose at the time of surveyor visits, and both the resident and staff were unable to recall when the TED hose were last applied. The resident reported that staff were not putting the TED hose on and expressed frustration that their needs and physician's orders were not being followed. Staff interviews indicated confusion regarding documentation requirements and assessment of edema, with some staff unsure how to properly assess or document the resident's condition. The care plan and physician order specifically required the use of TED hose, but this intervention was not implemented or monitored as directed. The facility's policies and procedures required that physician orders be accurately transcribed, implemented, and documented, and that care plans be person-centered and based on assessed needs. However, the lack of application, monitoring, and documentation of the TED hose for this resident resulted in the resident experiencing ongoing significant edema and pain, with staff unable to provide evidence of compliance with the prescribed interventions. The Director of Nursing confirmed the importance of following such orders and acknowledged that staff had not been recently in-serviced on edema assessment.