Failure to Honor Resident Preference for Compression Bandage Application
Penalty
Summary
Staff failed to honor a resident's stated preference regarding the timing of compression bandage application. The resident, who had a history of cellulitis, heart failure, and peripheral vascular disease, was cognitively impaired but able to express his wishes. Physician orders required ACE wraps to be applied to both lower extremities twice daily, with refusals documented. Multiple entries in the electronic medication administration record (EMAR) showed the resident repeatedly refused the application of ACE wraps in the early morning, stating he preferred them to be applied after his shower to prevent the wraps from getting wet or needing to be reapplied. Despite these documented preferences, staff continued to attempt application before the resident's shower and did not consistently accommodate his request. During interviews and observations, the resident reported that staff were not following his preference, resulting in his legs being left unwrapped after his shower. A CNA confirmed that the resident preferred post-shower application, but nurses did not always comply. Observation with the DON present confirmed the resident's legs were unwrapped after his shower, and the resident reiterated his preference for post-shower application. The DON initially stated the resident refused the wraps, but the resident clarified he only refused pre-shower application. The DON acknowledged that staff were not honoring the resident's preferences.