Failure to Assess and Document Shingles-Related Skin Condition
Penalty
Summary
The deficiency involves the facility’s failure to assess, monitor, and document a resident’s shingles-related blisters in accordance with its wound care and admission assessment policies and usual practice. The resident was originally admitted with diagnoses including anxiety disorder and hypertension and had moderately impaired cognitive skills, requiring varying levels of assistance with ADLs. A physician’s order directed that the shingles rash on the resident’s bilateral buttocks be cleansed with normal saline, patted dry, and covered with foam dressing daily for 14 days. On admission, a CNA observed red, painful dots on the resident’s lower back area, and the Treatment Nurse (TXN) later confirmed seeing red blisters due to shingles on the lower back when she assessed the resident. The TXN stated that the RN supervisor was responsible for documenting the resident’s skin condition related to the blisters but did not do so, and there was no documentation in the clinical record that the blisters were assessed, documented, and monitored for two weeks starting from the initial assessment date. The TXN also reported that she had been off work for the past two weeks and that the covering nurses did not complete the Weekly Skin Check for the resident during that period. The Infection Preventionist (IP) confirmed awareness that the resident had shingles and blisters upon admission and verified that there was no documentation indicating that the skin condition due to shingles had been assessed, documented, and monitored since admission. A covering LVN reported providing wound care for the resident for the prior two weeks but stated she did not know, and it was not endorsed to her, that she should assess and complete the Weekly Skin Check for the resident. The DON confirmed that the RN supervisor did not assess and document the resident’s shingles blisters on the Skin Check upon admission and that nurses did not assess and document the Weekly Skin Check on the specified subsequent weeks. Review of the facility’s wound care policy showed that nurses are required to record all assessment data obtained when inspecting wounds and any change in the resident’s condition in the medical record, and the admission assessment policy requires nurses to conduct and document physical and skin assessments at admission. The DON stated that, although the wound care policy did not specify follow-up frequency, the facility’s practice was to reassess and document shingles blisters weekly to monitor healing.
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