Failure to Implement Physician-Ordered Compression Stockings for Edema
Penalty
Summary
The facility failed to implement physician-ordered compression stockings for the treatment of edema for one resident. The resident was admitted with multiple diagnoses including COPD, hypertensive heart disease, type 2 diabetes, heart failure, weakness, and arthritis. A quarterly MDS showed the resident was independent in daily decision making but required substantial to maximum assistance with most ADLs. Weekly skin checks in early December documented bilateral leg cracking and clear drainage, and a subsequent health status note described bilateral lower extremities as edematous, hard, and with scant clear drainage. In response, a physician order was written for compression stockings to be applied in the morning and removed at bedtime daily for leg edema starting in December. Despite this order, surveyor observations and staff and resident interviews showed the intervention was not carried out. On observation, the resident’s lower legs were edematous, red, and had thin scabs, and the resident reported itching and scratching. The resident stated she had never worn compression hose at the facility, had not been asked about wearing them, and that at a prior facility her legs had been wrapped for edema. A CNA reported the resident was retaining a lot of fluid in her legs, had never been seen with compression stockings, that there were no stockings in the room, and that application of stockings did not appear in their electronic charting. The treatment record, however, was signed off indicating the stockings had been applied, and an RN acknowledged signing the treatment sheet for compression stockings when they had not actually been in place. This deficiency was cited under a complaint investigation.
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