Failure to Ensure Timely RN Assessment After Resident Burn
Penalty
Summary
A deficiency occurred when the facility failed to ensure timely notification of the RN supervisor and completion of an RN assessment after a resident experienced a change in condition. The resident, who had diagnoses including type 2 diabetes, anemia, and Charcot's joint, independently showered and sustained a first-degree burn to the right lower extremity after using a hot washcloth during a shower. The resident did not immediately report the injury to staff and later requested lotion for the affected area. Upon identification of the burn by staff, the RN supervisor was notified only via a non-urgent text message, which did not specify the nature of the incident. The RN supervisor did not follow up, and no RN assessment was completed at the time the burn was discovered. The administrator confirmed that an RN assessment should have been performed and that there was no documentation of such an assessment when the injury was first identified. The facility was unable to provide an assessment policy for review.