Failure to Provide Ordered Itch Relief and Skin Monitoring
Penalty
Summary
The facility failed to provide appropriate care and services for a resident experiencing persistent itching and multiple open skin scratches, as required by its own policies and procedures. The resident, who had a history of psychosis, mobility issues, and muscle wasting, was admitted with skin integrity problems, including open tears and excoriations related to dry skin and scratching. Despite physician orders for hydrocortisone cream and diphenhydramine to address the itching, the resident did not receive diphenhydramine, and hydrocortisone treatment was not continued after the order ended. Observations revealed the resident continued to scratch, resulting in numerous open wounds across the body, with both healed and new excoriations visible. Nursing staff interviews and record reviews indicated that weekly skin assessments were not performed as required, with the last documented assessment being incomplete and not reflecting the resident's current condition. Licensed nurses and the DON confirmed that there was a lack of ongoing monitoring and documentation of the resident's skin status, and that the physician was not notified when the resident's condition failed to improve. The resident's care plan included interventions for skin integrity, but these were not effectively implemented or followed up, as evidenced by the continued presence of open wounds and persistent itching. Further, there was no evidence of communication with the physician regarding the resident's ongoing symptoms until prompted by the surveyor. The wound consultant had never assessed the resident, and there were no wound consultant notes in the medical record. The facility's policies required daily observation for skin changes and weekly documented assessments, as well as prompt notification of the physician for any lack of improvement, but these protocols were not followed. As a result, the resident remained at risk for infection due to the ongoing skin breakdown and lack of effective intervention.