Failure to Apply Compression Stockings per Physician Orders
Penalty
Summary
The facility failed to apply compression stockings as ordered by physicians for two residents with cognitive impairments and multiple medical diagnoses. For one resident with Parkinson's disease, dementia, and other chronic conditions, physician orders required compression stockings to be applied to both lower extremities. However, during multiple observations, the resident was found without compression stockings, and both the wound care nurse and CNA were unaware of the order. The treatment administration record indicated the stockings were documented as applied, but direct observation contradicted this. The Director of Nursing confirmed that physician orders should be followed at all times and that documentation should reflect actual care provided. Similarly, another resident with severe cognitive impairment and diagnoses including metabolic encephalopathy, chronic kidney disease, Alzheimer's disease, and congestive heart failure had physician orders for daily application and removal of compression stockings. Observations on consecutive days found the resident without compression stockings, and several CNAs, including agency staff, were unsure of the resident's need for them despite signage in the room. The facility's policy requires adherence to physician orders, but staff failed to ensure the prescribed treatment was provided.