Failure to Follow Physician Orders for Compression Stockings and Inadequate Care Planning for Edema
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders and provide ordered compression stockings for a male resident with dementia, type 2 diabetes mellitus, chronic venous hypertension with bilateral lower extremity inflammation, atherosclerotic heart disease, CHF, and edema. The resident was dependent for all ADLs and had active orders for Lasix for edema and CHF, a cardiology consult, and compression stockings to be applied when out of bed. The comprehensive care plan did not include a focus or interventions for edema with compression stockings. During observation, the resident was seen sitting in a reclining wheelchair outside without compression stockings, with bare lower legs visible from the end of his trousers to the top of his socks, and both legs appeared red/dark red and visibly swollen. The assigned CNA stated the resident normally wore TED hose daily and that night shift CNAs usually applied them when residents were gotten out of bed; she acknowledged the resident should have had the stockings on when out of bed and that the previously assigned CNA had not applied them that morning. The assigned LPN stated the resident was supposed to wear TED stockings daily and acknowledged being told earlier that the resident’s feet were swollen; she said she had documented in the medical record that the stockings were on, explaining she assumed the task had been completed. The Unit Manager confirmed that the LPN had documented the stockings as applied and stated nurses were expected to document only after confirming orders were implemented; in a joint observation, the Unit Manager noted the resident’s legs were red and swollen and that the stockings should have been applied. The Interim DON also confirmed that the LPN had signed off that the compression stockings were applied, despite being informed they were not, and the facility assessment indicated the facility provided nursing services for monitoring and management of residents with chronic cardiac conditions.
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