Failure to Assess, Notify Physician, and Treat Change in Condition for Resident's Foot Injury
Penalty
Summary
The facility failed to assess, notify the physician, and treat a change in condition for a resident who presented with a swollen left foot, drainage, and dry, crusty debris covering the second toe and nail bed. Observation revealed the resident's left foot was swollen, with debris between the toes and a dried scab on the inside of the foot. The second toenail bed and top of the toe were covered with lumpy, yellow, crusty debris. A review of the resident's Shower/Bed Bath Sheet from seven days prior indicated a healing scab on the left foot, but there was no documented response or follow-up action by the licensed nurse, despite the form prompting for such action. During further evaluation, an LVN noted the second toe was swollen, dry, had drainage, and appeared infected, with no current treatments being administered. The CNA reported the resident had a history of injuring her left foot during a transfer, and the second toe had looked like a cauliflower since the initial injury. The LVN and DON both confirmed that a change of condition should have been completed, the physician notified, and new orders implemented when the skin issue was identified, but there was no evidence of ongoing treatment or monitoring. The facility's policy required physician notification and intervention for significant changes in a resident's condition, which was not followed in this case.