Failure to Assess and Monitor Skin Discoloration in Resident on Anticoagulant Therapy
Penalty
Summary
A resident with diagnoses including anemia, atrial fibrillation, heart failure, hypertension, and dementia was observed on two separate occasions to have a dark purple discoloration on the top of his right hand. The resident was cognitively impaired, required substantial assistance with mobility and dressing, and was receiving anticoagulant therapy (Eliquis) for atrial fibrillation. The care plan indicated the resident was at risk for abnormal bleeding due to anticoagulant use and included interventions to inspect the skin for bruising and notify nursing staff of abnormal findings. Despite these interventions, there was no documentation in the medical record that the discoloration had been assessed or monitored. The weekly skin assessment did not note any new skin concerns, and the wound nurse was unaware of the discoloration until interviewed by surveyors. The facility did not provide a policy regarding the assessment or monitoring of skin discolorations.