Failure to Develop Comprehensive Care Plan for Skin Issues and Scratching Behavior
Penalty
Summary
The facility failed to develop a comprehensive care plan for a resident who was readmitted with new skin issues and a known behavior of skin scratching. Upon readmission, the resident was found to have scattered skin scrapes on the right and left buttocks and right scrotum, as documented in the medical record. Despite these findings, no care plan was initiated to address the new skin issues, and the only intervention ordered was to monitor the affected areas. Multiple licensed nurses confirmed during interviews that a care plan should have been created at the time of readmission to track wound healing and implement appropriate interventions. Additionally, the resident exhibited a behavior of self-scratching, which was observed by staff and reported by certified nurse assistants. This behavior was known to contribute to the resident's ongoing skin issues, particularly given the resident's history of end stage renal disease and dialysis, which increased the risk of dry skin and open wounds. Despite staff awareness of the scratching behavior, there was no care plan or behavior monitoring order initiated to address or mitigate this behavior. Facility policies required that a comprehensive care plan be developed and updated upon readmission and when new issues or behaviors were identified. Interviews with nursing staff and the Director of Nursing confirmed that the expectation was for care plans to be created for both new skin issues and observed behaviors such as scratching. The absence of these care plans was verified through record review and staff interviews, indicating a failure to follow facility policy and standard care planning procedures.