Failure to Follow Physician Orders for Compression Devices and Monitoring
Penalty
Summary
Three residents did not receive care and treatment in accordance with physician orders, as observed through record review, staff and resident interviews, and direct observation. One resident with a history of left total knee arthroplasty, cellulitis, diabetes, and congestive heart failure (CHF) had orders for daily weights and edema assessments to monitor for fluid retention, as well as orders for the application and removal of TED hose and Tubigrip bandages. Staff failed to obtain and document daily weights on specific days and did not consistently perform or document edema assessments as ordered. Additionally, the resident did not have TED hose orders upon admission despite wearing them, and after an order change to Tubigrips, staff continued to use TED hose instead of following the updated order. Two other residents with diagnoses including CHF, atrial fibrillation, chronic kidney disease, muscle wasting, and vascular dementia had physician orders for Tubigrip stockings to be applied in the morning and removed in the evening. Observations and interviews revealed that staff did not consistently remove the Tubigrips at night as ordered, resulting in the residents wearing them overnight. Both residents and their representatives reported that staff sometimes forgot to remove the Tubigrips, and this was corroborated by staff interviews and direct observation. The facility lacked a written policy for the application and removal of TED hose and Tubigrip stockings, relying solely on medical orders. The Director of Nursing confirmed that staff did not follow the care plans and medical orders regarding daily weights, edema assessments, and the application and removal of compression devices for the affected residents.