Failure to Include Pacemaker and Compression Stockings in Comprehensive Care Plan
Penalty
Summary
The deficiency involves the facility’s failure to develop an individualized, comprehensive care plan that addressed a resident’s pacemaker and use of compression stockings. A male resident with dementia, cognitive communication deficit, type 2 diabetes mellitus, chronic venous hypertension with bilateral lower extremity inflammation, atherosclerotic heart disease, chronic atrial fibrillation, CHF, and edema was admitted from another nursing home and later readmitted from an acute care hospital. The hospital transfer form (3008) documented that the resident had a pacemaker, and active physician orders included Eliquis for atrial fibrillation, Lasix for edema and CHF, Toprol for hypertension, compression stockings to be applied when out of bed, and a cardiology consultation. The most recent Quarterly MDS showed moderate cognitive impairment and dependence on staff for all ADLs, and that the resident was receiving high‑risk anticoagulant, diuretic, and antiplatelet medications. On review of the current comprehensive care plan, surveyors found that it did not include the resident’s edema with compression stockings or the presence and monitoring of the pacemaker. The Interim DON confirmed the resident had a pacemaker and could not locate any physician orders to monitor the pacemaker, nor care plan entries for the device or for compression stockings related to edema. The MDS Coordinator stated that comprehensive care plans were developed and revised using the medical record, new orders, face‑to‑face assessments, and IDT discussions, and acknowledged that the care plan for this resident had not been updated to include the pacemaker and compression stockings until the previous evening, despite these needs being present since the beginning. The facility’s written policy required that comprehensive care plans include measurable objectives, interventions, goals, and timetables and be developed within specified time frames, but these elements were not applied to the resident’s pacemaker and compression stocking needs.
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