Failure to Document and Apply Physician-Ordered TED Hose
Penalty
Summary
The facility failed to provide documentation of a resident's status and care related to the application of Thrombo-Embolic Deterrent (TED) hose stockings, as required by the facility's policy and procedure for nursing documentation. Despite a physician's order for the resident to wear TED hose on both lower extremities for leg swelling/edema, nursing staff did not document when the TED hose were applied or removed. Review of the resident's medication and treatment administration records showed no indication that the TED hose were being applied as ordered. Interviews with licensed nurses and the Director of Nursing confirmed that the lack of documentation was due to the way the order was transcribed, and staff were not monitoring or recording the use of TED hose or the resident's edema status. The resident involved had a history of chronic obstructive pulmonary disease, heart failure, and type II diabetes mellitus, and required substantial assistance with dressing. Observations confirmed that the resident was not wearing TED hose at the time of the survey, and staff were unable to state when the TED hose were last applied. The facility's policy required concise, clear, and accurate documentation of treatments completed as per physician orders, but this was not followed in the case of the resident's TED hose application.