Failure to Update Care Plans for Hospice, Code Status, Wounds, and Tube Feeding
Penalty
Summary
The deficiency involves the facility’s failure to update and accurately maintain comprehensive care plans in response to changes in residents’ conditions and physician orders. Facility policy dated October 1, 2024, required nursing staff to update care plans based on physician orders and changes in care needs, and to initiate or update acute care plans as warranted. For one resident with a gangrenous right foot and arterial ulcers on the first through fourth digits, progress notes from mid-August through early December documented hospice services and wound treatments, and active physician orders included hospice care and a DNR order. However, the resident’s care plan, originally dated in 2020 and 2021, still listed both DNR and Full Code status and did not reflect the arterial ulcers, the gangrenous condition of the right foot, or the resident’s hospice care needs. The DON confirmed that the care plan had not been updated to reflect the resident’s wounds, hospice needs, or current code status. A second resident had multiple conditions including dysphagia in the oropharyngeal phase and was receiving enteral nutrition. Physician orders dated in late August specified Glucerna 1.2 via feeding pump at 65 ml/hr until a total volume of 1300 ml was infused each dayshift, with documentation of total volume infused. The resident’s care plan, however, still reflected an older enteral nutrition regimen for Nepro at 70 ml/hr for 15 hours, initiated in November of the prior year, and had not been revised to match the current Glucerna order. During an interview, an LPN reviewed the current tube feeding order and confirmed that the care plan should have been updated to reflect the Glucerna 1.2 at 65 ml/hr via feeding pump. These findings showed that the facility did not ensure care plans were updated to align with current physician orders and residents’ clinical conditions for hospice care, code status, vascular wounds, and tube feeding.
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