Failure to Apply and Accurately Document Physician-Ordered TED Hose
Penalty
Summary
Facility staff failed to follow a physician's order for a resident requiring TED hose (compression stockings) to be applied to both lower extremities each morning when out of bed and removed at bedtime. Despite documentation in the Medication Administration Record (MAR) indicating that the TED hose were applied daily, multiple observations revealed that the resident did not have the TED hose on during the required times. The resident, who was severely cognitively impaired and had diagnoses including cerebral infarction, hemiplegia, and lower leg atrophy, was observed attempting to communicate the need for the TED hose and was seen retrieving them from a drawer himself. Staff interviews confirmed that the TED hose were not consistently applied as ordered. Further review of facility policies showed requirements for accurate and objective documentation, and for staff to sign the MAR only after administration of care or medication. However, interviews with LPNs revealed that staff sometimes documented the application of the TED hose without actually performing the task, with one LPN admitting to marking the MAR without having put on the hose and another stating she was unaware of the order for the TED hose. The Director of Nursing confirmed that it was expected for staff to document care in real time and not to mark tasks as completed if they had not done them.