Failure to Provide Ordered Edema Care and Leg Elevation
Penalty
Summary
A deficiency was identified when a resident with diagnoses including hemiplegia following cerebral infarction, morbid obesity, and heart failure did not receive care in accordance with physician orders and professional standards. The resident's care plan and physician orders required the left foot to be wrapped with an ace bandage for 12 hours daily, applied in the morning and removed at bedtime, and for the legs to be elevated as much as possible during the day. However, observations on multiple days showed the resident sitting in a chair with both lower legs exhibiting 2-3 plus edema, without the left foot ace wrap in place and without leg elevation. Documentation confirmed inconsistent application of the ace wrap, and there was no evidence in the Certified Nurse Aide Tasks addressing leg elevation. Interviews with the resident revealed that they were aware of the need for leg elevation and the ace wrap, but reported that staff often delayed or failed to apply the wrap in the morning and did not provide a means to elevate their legs when out of bed. The resident stated they had requested assistance multiple times without resolution. Staff interviews confirmed a lack of awareness regarding the need for leg elevation and acknowledged delays in applying the ace wrap, with some staff unaware that the resident lacked equipment to elevate their legs. These actions and omissions resulted in the resident not receiving care as ordered and as per professional standards.