Failure to Incorporate Skin Integrity Interventions into Care Plans
Penalty
Summary
The facility failed to incorporate appropriate skin integrity interventions into the care plans for two residents who were reviewed for skin conditions. One resident was admitted with multiple complex medical diagnoses, including a history of myocardial infarction, chronic atrial fibrillation, diabetes, stage 5 chronic kidney disease, and a left below-knee amputation. This resident required maximum assistance with activities of daily living and had a stage two pressure ulcer on admission, as well as a total of fourteen wounds identified during the facility's skin/wound assessment. Despite these findings, the resident's care plan did not include documentation of wounds, wound care, or interventions aimed at preventing further deterioration of skin integrity. Another resident was admitted with diagnoses including non-pressure chronic ulcers on both lower legs, varicose veins with ulceration, a stage 3 pressure ulcer on the left heel, and localized edema. The care plan for this resident did identify some skin integrity issues and listed interventions such as use of an air mattress, encouragement of nutrition and hydration, heel protection, and regular repositioning. However, physician orders for heel protectors were not consistently reflected in the care plan, and documentation indicated that heel boots were not in place at times due to drainage and odor, with pillows being used instead. Interviews with staff and administration confirmed that not all interventions for prevention and management of skin breakdown were included in the care plans, as required by facility policy.