Missed Quarterly Smoking Evaluation for Resident with Cognitive Impairment
Penalty
Summary
A deficiency occurred when the facility failed to ensure that smoking evaluations were completed quarterly for a resident who continued to smoke. The resident, who had a primary diagnosis of Alzheimer's dementia and a severely impaired cognition as indicated by a BIMS score of 7, was identified as being at risk for injury related to smoking. The care plan for this resident included interventions such as completing smoking evaluations on admission, quarterly, and as needed to determine the resident's ability to smoke independently or require staff assistance. However, record review showed that a quarterly smoking evaluation was missed, as there was a gap between completed assessments. Interview with the assistant director of nursing (ADON) confirmed that the resident, despite having gone six months without smoking, should have still been considered a smoker and required ongoing evaluations per facility policy. The facility's updated smoking policy required all residents who smoke to be assessed during each quarterly or comprehensive MDS assessment, and further evaluated for safe smoking practices. The ADON acknowledged that a quarterly smoking evaluation had been missed for this resident, which was not in compliance with the facility's policy.