Injury and Infection Following Improper Nail Care for Diabetic Resident
Penalty
Summary
Facility staff failed to prevent an injury to a resident when a nursing assistant (NA) used an electric nail file to apply acrylic nails, resulting in a cut to the resident's finger. The resident had a diagnosis of diabetes and was assessed as cognitively intact, with a care plan indicating a risk for unstable blood sugars and a need for assistance with activities of daily living. According to facility policy, nursing assistants are not permitted to perform nail care on residents with diabetes or vascular disease; such care must be provided by a licensed nurse or podiatrist. Despite this, the NA performed nail care using an electric nail file on the diabetic resident, unaware of the resident's diagnosis and the associated restrictions. Following the nail care, the resident developed pain, redness, tenderness, and swelling in the right hand and arm, with symptoms rapidly progressing. Medical records documented that the resident was sent to the emergency department for probable intravenous therapy. The resident was subsequently admitted to the hospital for septic arthritis of the right index finger and underwent surgical intervention to remove infected tissue. Cultures revealed a Methicillin-resistant Staphylococcus aureus (MRSA) infection. The resident continued on antibiotics after returning from the hospital. Interviews with facility staff revealed that the NA was not aware of the prohibition against providing nail care to diabetic residents and did not realize the resident was diabetic. The NA admitted to using an electric nail file but denied causing injury or observing any immediate signs of harm. The administrator acknowledged that the NA was not supposed to perform acrylic nails or clip nails due to lack of certification. Both the facility and hospital physicians indicated that the use of the electric nail file could have contributed to the resident's infection and subsequent hospitalization.