Failure to Notify MD of New Bruising and Skin Change
Penalty
Summary
The facility failed to notify the physician of a change in condition for one resident who was observed with a purple skin discoloration on the right upper arm. During an observation and interview in the resident’s room, the discoloration measured more than an inch, and the resident reported not knowing the cause, speculating it might have occurred when going to the bathroom. The resident stated she was unsure if nursing staff were aware of the bruise and that nothing had been applied to it. Review of her records showed she had diagnoses of diabetes mellitus, hypertension, and congestive heart failure, had intact cognition and decision-making capacity, and required assistance with ADLs including dressing, toileting, personal hygiene, transfer, and mobility. The resident’s care plan for potential skin breakdown, related to thin fragile skin, directed staff to perform daily body checks and to monitor, document, and report to the physician any changes in skin status, including bruises or discolorations, and to notify the nurse of new areas of skin breakdown noted during care. In an interview, an LVN stated she had not been informed of the resident’s arm bruise and confirmed the physician had not been notified. The LVN also stated the bruise should have been assessed for size, redness, hardness, and possible blood thinner use, and the cause should have been identified. Facility policy on Skin and Wound Monitoring and Management required licensed nurses to assess and document skin issues and obtain and implement treatment orders as appropriate, and required CNAs to report skin discolorations to licensed nurses, but this process did not occur for the resident’s arm bruise.
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