Failure to Follow Physician Orders for Compression Devices and Stockings
Penalty
Summary
The facility failed to provide care and services according to accepted standards of clinical practice for three residents by not following physician orders for the application of Thrombo-Embolic Deterrent (TED) stockings and lymphatic compression devices. One resident, admitted with endocarditis and generalized muscle weakness, had physician orders for TED hose to be applied every morning and removed in the evening, as well as for a lymphatic compression device to be offered after meals. During observation and interview, the resident was found wearing regular socks instead of TED stockings and reported that the compression device had not been offered. The assigned nurse confirmed the devices were not applied as ordered and that the compression device was stored out of sight in the resident's room. Another resident, admitted with congestive heart failure and muscle weakness, had an order for compression stockings to be worn during the day and removed at night, as well as an order for daily weights. Observations revealed the resident was not wearing compression stockings, and record review showed daily weights were not completed as ordered. The Director of Staff Development confirmed the omission of daily weights and the absence of compression stockings during review of the resident's records. A third resident, admitted with muscle weakness and multiple sclerosis, had an order for TED hose to be applied in the morning and removed at bedtime. During observation and interview, the resident was not wearing TED hose and stated she had never been fitted for them while at the facility. The physical therapy assistant and licensed nurse confirmed that TED hose were not available among the resident's belongings and had not been applied. The Director of Nursing and Nurse Practitioner both stated their expectation that staff follow physician orders as written. Facility policy also required that prescribed medication and treatment orders be carried out as prescribed.