Failure to Timely Assess, Treat Skin Impairments and Administer Medications
Penalty
Summary
The facility failed to assess and treat new skin impairments in a timely manner and according to physician's orders for two residents. One resident, with a history of stroke and significant physical impairment, developed a skin wound on the right forearm after receiving electrical stimulation therapy. The wound was first identified by therapy staff, but there was no timely or thorough nursing assessment or documentation of the new skin issue. Weekly skin assessments were incomplete or missing for several weeks, and the wound was not properly evaluated or treated until it became infected, requiring antibiotics. Physician orders for wound care were not promptly entered into the Medication Administration Record (MAR) or Treatment Administration Record (TAR), resulting in missed treatments. Even after the wound was considered resolved by a wound care provider, dressings continued to be applied, and there was a lack of documentation and communication regarding the wound's status. Another resident was observed with significant skin impairment on the right shin, including blistering and drainage, but there were no treatment orders in place at the time of initial observation. Treatment orders were only initiated after the wound was observed and noted by surveyors, indicating a delay in response to the resident's condition. The Director of Nursing confirmed that treatments should be implemented immediately upon identification of a wound or skin impairment, but this did not occur in these cases. Additionally, the facility failed to ensure that prescribed cardiac medications were administered to a newly admitted resident. The resident did not receive several critical medications because staff did not utilize the back-up medication supply, despite these medications being available. The MAR indicated that medications were held while waiting for pharmacy delivery, and the Director of Nursing acknowledged that the medications could have been administered from the back-up supply. The facility's medication administration policy did not address the use of back-up medication supply for such situations.