Failure to Implement Physician-Ordered Edema Management Treatments
Penalty
Summary
The deficiency involves the facility’s failure to implement physician-ordered interventions to manage lower extremity edema for two residents. For one resident with diagnoses including lymphedema, chronic venous hypertension with lower extremity ulcer, chronic peripheral venous insufficiency, morbid obesity, cellulitis, and a history of transient ischemic attack, the care plan addressed risk for impaired skin integrity and included interventions such as pressure-relieving/reducing mattress use and skin monitoring. A physician order directed that bilateral lower extremities be washed, patted dry, and wrapped with UNNA boot dressings from toes to below the knee, covered with Coban, to be changed three times weekly and as needed, with triad paste and roll gauze plus Coban as an alternative if UNNA boots were unavailable. On observation, the resident was in bed without any pressure relief boots or wraps in place, and the RN confirmed the absence of ordered treatments and assessed the resident as having +3 edema in both lower extremities. For a second resident with diagnoses including intracerebral hemorrhage, right-sided hemiplegia, seizure disorder, anxiety disorder, deep vein thrombosis and embolism of the right lower extremity, chronic respiratory condition, tracheostomy, gastrostomy, and anemia, the care plan addressed impaired self-care and mobility deficits and included application of ace wraps to the right lower leg from toes to knee. A physician order specified ace wraps to the right lower leg from toes to knee each shift as tolerated for edema. During observation, this resident was seated at the bedside with feet on the floor and no wraps applied to the lower extremities. An LPN verified that the leg wraps were not in place, assessed +3 edema in the right lower extremity, and the resident reported that the wraps had not been applied for the past three days. These findings show that physician-prescribed treatments for edema management were not implemented as ordered for both residents.
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