Failure to Complete Thorough Skin Assessment on Readmission
Penalty
Summary
A deficiency occurred when a licensed vocational nurse (LVN) failed to complete a thorough and accurate head-to-toe assessment for a male resident with multiple diagnoses, including cerebral infarction, muscle wasting, intellectual disabilities, hemiplegia, and hemiparesis, upon his readmission to the facility. The resident had a Coban wrap on his right arm, and the care plan specifically addressed an actual impairment to skin integrity at the right antecubital fossa related to the Coban wrap. Despite this, the LVN did not assess what was under the dressing/bandage during the initial assessment, and there was no documentation or mention of the resident's arm in the progress notes for several days following readmission. The resident was noted to have a dressing on his arm for approximately eight days without any clinical staff member assessing underneath it. The LVN reported that she noticed the dressing upon the resident's return but did not remove it or insist on assessing the underlying skin, citing the resident's resistance to care. The LVN acknowledged in hindsight that she should have advocated more strongly to assess under the dressing, as this is part of her professional responsibilities and necessary to ensure there were no negative outcomes such as loss of circulation or skin breakdown. The resident did not express or exhibit any signs or symptoms of distress during this period, and when interviewed, he recalled the incident but had no current concerns. An external advocate and the Director of Nursing (DON) both confirmed that the dressing remained in place for several days and that a thorough assessment should have been completed upon readmission. The facility's protocols and clinical guidelines require examination of the skin under all dressings for new admissions and readmissions, but this was not followed in this instance. The failure to assess under the Coban wrap could have compromised the resident's skin integrity, as noted in the report.