Failure to Implement Physician-Ordered Compression Therapy and Abdominal Binder
Penalty
Summary
The facility failed to develop and implement a comprehensive care plan and furnish services according to physician orders for one resident. The resident, who had a history of left tibia fracture, diabetes mellitus, hypothyroidism, and morbid obesity, was ordered to receive lymphedema therapy, daily application of personal lotion, and to wear compression stockings or ACE wraps, as well as an abdominal binder. Despite these orders, the resident's care plan did not include the use of compression stockings, ACE wraps, or the abdominal binder. Observations revealed that the resident was not wearing the required compression devices or abdominal binder, and her legs were swollen and red with multiple weeping blisters. Compression stockings and ACE wraps were found in her closet, but had not been applied. Interviews with staff indicated a lack of awareness and follow-through regarding the resident's treatment orders. The resident reported not wearing the abdominal binder for weeks due to it being missing, and staff confirmed they were unable to locate it and had reported this to the nurse manager. Nursing staff were not aware of the current orders for compression stockings or ACE wraps, and the nurse manager was unaware of the missing binder or the absence of compression devices. The Director of Nursing stated that ordered treatments should be provided unless refused or discontinued, but there was no documentation of refusal or discontinuation. The facility's care planning policy requires comprehensive care plans to be updated as resident needs change, which was not followed in this case.