Failure to Revise Care Plan for Pressure Ulcer Intervention Refusals
Penalty
Summary
The facility failed to revise the care plan for a resident with a chronic right heel wound and diabetic foot ulcer who was refusing physician-ordered pressure-relieving interventions. The resident, who had diagnoses including diabetes, heart failure, and a prosthetic heart valve, was cognitively intact and required maximal assistance for personal care and mobility. Despite having orders for the use of heel suspension boots while in bed to address a right heel ulcer, the care plan did not address the resident's refusals to wear the boots or provide alternative interventions. Observations confirmed that the resident was not wearing the boots as ordered and reported only being able to tolerate them for limited periods due to discomfort. Staff interviews revealed that the LPN was aware of the resident's refusals but did not know the reasons or have alternative approaches documented. The care plan and physician orders were reviewed and confirmed to lack documentation regarding the resident's refusals and did not outline specific interventions for such situations. The facility's policy required care plans to be updated as resident needs changed, but this was not done in response to the resident's ongoing refusal of a key pressure-relieving intervention.