Failure to Timely Revise Care Plans After New Skin Impairments Identified
Penalty
Summary
The facility failed to review and revise Resident Care Plans (RCPs) to include additional interventions after the identification of new skin impairments for three residents. For one resident with a history of cellulitis, rheumatoid arthritis, and chronic pain syndrome, a new open area on the right foot was identified and treated, but the RCP was not updated to reflect the presence of rheumatoid arthritis nodules or the new skin impairment until more than a month later, after the resident had passed away. Documentation showed that the resident had multiple wounds, including a large full-thickness wound, but the care plan did not include these findings or new interventions in a timely manner. Another resident with subarachnoid hemorrhage and epilepsy developed pressure ulcers on the right lateral foot and ankle, which remained unhealed for several months. Although nursing notes indicated that the RCP was updated with new interventions, a review of the clinical record did not show any revisions or additional interventions added to the RCP for over a year. The care plan continued to list only general interventions, such as skin inspection and offloading heels, without addressing the new or ongoing wounds. A third resident with dementia, diabetes, peripheral vascular disease, and neuropathy developed a diabetic wound on the right second toe. Nursing documentation noted the wound and indicated that the RCP was updated, but no revisions or new interventions were found in the care plan for nearly a year. Interviews with nursing staff confirmed that RCPs should be revised immediately upon discovery of new skin impairments, but they were unable to explain why this was not done for these residents. Facility policies required timely and interdisciplinary updates to care plans to address changes in resident status, but these were not followed in the cases reviewed.