Failure to Provide Consistent Assessment, Monitoring, and Treatment for Resident with Complex Needs
Penalty
Summary
A resident with a complex medical history, including chronic lymphedema, morbid obesity, heart failure, chronic constipation, and hyperkalemia, experienced multiple failures in care delivery. The facility did not consistently assess, monitor, document, or provide treatment according to professional standards and physician orders. The resident reported significant pain from constipation and requested an enema, which was refused by nursing staff despite her history of fecal impaction. She was later hospitalized for fecal impaction and dangerously high potassium levels. Hospital records confirmed severe constipation, hyperkalemia, and the need for disimpaction and urgent medical intervention. The resident also reported that wound care was not being provided as ordered. She had open, weeping areas on her legs due to lymphedema, and facility staff used incontinence briefs instead of prescribed wound dressings when supplies ran out. The resident stated that she often had to clean her own wounds, and there were periods when the wound nurse did not assess her skin as scheduled. Documentation and interviews confirmed missed applications of compression stockings and lymphedema boots, with no progress notes indicating resident refusal. Supply orders for wound care were not consistently maintained, leading to lapses in appropriate wound management. Review of the Medication Administration Records (MAR) revealed multiple missed treatments, including compression stockings and lymphedema boots, without documentation of resident refusal. There were also inconsistencies in the administration and documentation of bowel management interventions, such as enemas and laxatives. Staff interviews indicated a lack of communication and follow-through regarding supply shortages and resident care needs. These failures resulted in the resident's hospitalization and ongoing issues with wound care, bowel management, and monitoring of critical lab values.