Failure to Consistently Apply and Document Lymphedema Boot Therapy
Penalty
Summary
The facility failed to provide care and services as ordered for a resident with lymphedema, as evidenced by inconsistent application and documentation of lymphedema boots. The resident was admitted with diagnoses including lymphedema and had intact cognition. Physician orders specified that nursing staff were to apply lymphedema boots for one hour, twice daily, to reduce swelling. However, review of the Medication Administration Records (MAR) for several months showed incomplete and inconsistent documentation, with no clear evidence that the boots were applied as ordered. The MAR did not allow for proper documentation of the required one-hour duration, and entries were often marked only as 'on' or 'off' without time specifics. Multiple observations and interviews confirmed that the resident did not have the lymphedema boots applied during several day and night shifts, and the resident reported never refusing the treatment. The resident stated she could not apply the boots herself and required assistance, which was not consistently provided. Staff interviews corroborated that the boots were rarely applied, and the DON acknowledged the MAR was not set up to document the treatment as ordered. There was no documented evidence that the boots were applied as prescribed or that the resident refused the treatment.