Failure to Timely Assess and Intervene for Skin Integrity Issues
Penalty
Summary
The facility failed to ensure that residents received timely assessment, monitoring, and implementation of appropriate interventions for skin integrity concerns, resulting in deficiencies for two residents. For one resident admitted with multiple stage 2 pressure injuries and bruising, documentation showed that although wounds were identified upon admission, there was a lack of timely care plan initiation and physician orders for wound care. The care plan and treatment orders were not established until several days after admission, despite the presence of significant skin issues. The Director of Nursing confirmed that there was no care plan in place upon the resident's return from the hospital and that wound care orders were not entered as required. Another resident was admitted with a history of cerebral infarction and diabetes mellitus and was found to have an open area with redness and swelling on the left thigh. Although an incident report was completed and the nurse practitioner was notified, there was a delay in documenting the skin assessment and initiating a care plan. The care plan for the wound was not started until after the resident returned from the hospital, well beyond the required timeframe. Progress notes indicated that the wound worsened, leading to a hospital transfer for surgical evaluation. The Director of Nursing acknowledged that the care plan should have been initiated within 24 hours but was not. Facility policies require a full body skin assessment on admission, timely documentation, prompt initiation of care plans, and immediate notification of providers and families for new skin impairments. However, in both cases, there were lapses in following these protocols, including delays in documentation, care plan initiation, and implementation of physician orders for wound care. These failures resulted in residents not receiving the necessary care and services to maintain their highest practicable physical well-being, as required by professional standards and facility policy.