Failure to Timely Update Care Plan for Multiple Pressure Ulcers and Catheter-Related Wound
Penalty
Summary
The deficiency involves the facility’s failure to timely and comprehensively update a resident’s care plan to reflect existing and newly developed pressure ulcers and related interventions. The resident was admitted with paraplegia, type 2 diabetes, obesity, and a documented right heel wound on the Nursing Admit/Re-admit Data Collection, but that form lacked required descriptive details such as staging, blanchability, size, color, odor, or discharge. The admission MDS identified the resident as at risk for pressure ulcers, with significant lower extremity impairment, dependence for lower body care and transfers, and use of pressure-reducing devices, but no pressure ulcers were documented at that time. The initial care plan dated the day after admission did not include a skin integrity focus or identify the right heel wound, although it did address assistance needs for turning and transfers. A subsequent care plan identified only potential for pressure ulcer development and general preventive interventions, without specifically addressing the existing right heel wound. As the resident’s condition evolved, the facility did not revise the care plan to reflect new pressure ulcers and specific wound-related interventions in a timely manner. An RN wound assessment later identified an unstageable right heel pressure ulcer, but the assessment did not address a red sacrum noted on the same date, and the care plan was not updated at that time to include off-loading boots, which were only added months later. A progress note documented a new pressure sore on the right buttock and the resident’s refusal to get up in a chair at mealtimes despite education on repositioning, yet there was no indication the care plan was revised to address this new wound. A wound clinic report then identified a stage 3 right heel ulcer and a stage 3 ulcer at the urinary meatus related to catheter tension and incontinent brief use, with specific directions regarding catheter device positioning, removal of the brief, and use of barrier cream. The record showed no corresponding care plan revisions to include the new urinary meatus ulcer or the clinic’s catheter and incontinent garment interventions until a later date, and interventions for prevention/minimization of recurrent buttock shearing injuries were also delayed, contrary to the DON’s stated expectation that RN nurse leaders update care plans with changes.
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