Failure to Ensure Proper Positioning and Edema Device Application
Penalty
Summary
The facility failed to ensure proper wheelchair positioning for a resident during meal times, as observed on multiple occasions. The resident, who had dementia and was on hospice care, was consistently seated in a Broda-style wheelchair in a reclined position while eating. This positioning required the resident to lean forward significantly, approximately 12 to 14 inches, to reach the meal plate, which was positioned at chest level due to the low height of the wheelchair seat relative to the table. Staff did not attempt to correct the resident's posture during meal service, and there was no evidence in the medical record of a comprehensive evaluation or assessment for alternative interventions to improve eating posture. Interviews with staff revealed a lack of awareness and evaluation regarding the resident's eating position, and no facility policy on wheelchair positioning was provided. Additionally, the facility failed to ensure that medical devices for edema management were consistently applied for another resident with lymphedema and congestive heart failure. Physician orders required the use of TED stockings for 12 hours on and 12 hours off, as well as daily lymphedema wraps. However, documentation showed that these devices were rarely applied, with most days marked as refused, sleeping, or hospitalized. The resident reported not having worn TED stockings since returning from the hospital and never having used lymphedema wraps. Staff interviews indicated a lack of consistent application and assessment of the resident's preferences or alternative approaches to device use, especially considering the resident's sleep patterns and refusals. In both cases, the facility did not provide documentation of relevant policies (wheelchair positioning or edema management) when requested. The deficiencies were identified through observation, interviews, and document review, highlighting failures to provide care and treatment according to physician orders and resident needs, specifically regarding proper positioning for eating and consistent application of medical devices for edema management.