LPNs Performed Pressure Ulcer Staging Outside Defined Scope and Job Descriptions
Penalty
Summary
The deficiency involves the facility’s failure to ensure that LPNs practiced within their professional standards and scope of training regarding pressure ulcer assessment and staging, as required by applicable laws and accepted professional standards. For Resident #20, who had Alzheimer’s disease, depression, spinal stenosis, osteoarthritis, severe cognitive impairment, dependence for most ADLs, incontinence, and was at risk for pressure ulcers, multiple skin issue assessments were completed by LPN #1500. These assessments documented an in-house acquired right heel unstageable pressure ulcer with specific measurements and tissue composition, followed by subsequent documentation of the same right heel wound as a stage 3 pressure ulcer on later dates, with changing measurements and wound bed composition. On observation and interview, LPN #1500 confirmed that she personally measured and staged the right heel pressure ulcer and would document the assessment in the chart. The DON verified that LPN #1500 was the one who staged and measured this resident’s right heel pressure ulcer on three specific dates. For Resident #30, who was admitted with diagnoses including severe protein calorie malnutrition, hemiplegia and hemiparesis after cerebral infarction, muscle weakness, and a stage 4 sacral pressure ulcer, LPN #1500 also completed skin issue assessments. These assessments documented a sacral stage 4 pressure ulcer with detailed measurements and wound bed composition on two separate dates. The DON confirmed that LPN #1500 assessed, staged, and measured this resident’s sacral stage 4 pressure ulcer on those dates. Review of the facility job descriptions for the Treatment Nurse and Unit Manager positions showed no inclusion of pressure ulcer wound assessments, including measuring, staging, and assessments, in their essential functions. The facility was unable to provide any job description for LPNs, and thus there was no documented authorization or role definition for LPNs to perform pressure ulcer wound assessments and staging, despite LPN #1500 performing these functions for at least two residents.
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