Failure to Apply TED Hose as Ordered for Edema Management
Penalty
Summary
The facility failed to follow a physician's order to apply thrombo-embolic-deterrent (TED) hose to a resident's lower extremities each morning to manage edema. The resident, who had multiple diagnoses including pain, hypertension, insomnia, cognitive-communication deficit, history of falls, muscle weakness, hyperlipidemia, aphasia, COPD, and dementia, was documented as requiring substantial to maximal assistance with daily activities and was receiving diuretic therapy for edema. The care plan and physician's orders specified that TED hose should be applied every morning and removed at bedtime to support skin integrity and manage swelling. Despite these orders, observations on multiple mornings showed the resident without TED hose, wearing only nonskid socks. Interviews with nursing staff and administration revealed a lack of clarity regarding responsibility for ensuring the TED hose were applied as ordered. Staff acknowledged that it was a shared duty among nursing personnel, but the resident was repeatedly observed without the prescribed compression stockings during morning hours.