Failure to Obtain Orders and Monitor JP Drain and Wound VAC After Admission
Penalty
Summary
The deficiency involves the facility’s failure to obtain and implement physician orders and to monitor a resident’s right thigh Jackson Pratt (JP) drain and right lower quadrant (RLQ) abdominal wound vacuum following admission. The resident was admitted with a history of hemiplegia and hemiparesis following cerebral infarction and diabetes mellitus, and had recently undergone surgery on a right thigh tumor. The admission assessment documented the presence of a wound vacuum from the RLQ abdomen to the perineal area and a JP drain on the right thigh, and the physician’s plan included wound care for the right thigh ulcer with monitoring for drainage. However, the Order Summary Report on the admission date showed no physician orders to monitor, empty, and record JP drain output, and no orders to monitor or change the wound vacuum canister. Record review showed no evidence that the JP drain and wound vacuum were monitored on the evening shift of the admission date or on the subsequent night shift. The Treatment Administration Record for that month confirmed that monitoring and recording of JP drainage every shift did not begin until the day after admission and that there was no monitoring of the JP drain or its stoma sites on the evening and night shifts of the admission date. Similarly, orders and documentation for continuing and monitoring the wound vacuum every shift began the day after admission, with no such monitoring documented for the evening and night shifts immediately following admission. In interviews, treatment nurses and LVNs acknowledged that there were no orders on the admission date to monitor, drain, and record JP drainage or to monitor, continue, and change the wound vacuum canister, and they confirmed that they did not perform or document these tasks on the evening shift. The admitting RN stated that although the resident was admitted with a JP drain and wound vacuum, the RN did not verify and obtain orders from the physician to monitor, drain, and record JP output or to monitor and change the wound vacuum on the admission date. The DON stated that the facility should monitor, drain, and record JP drainage and monitor, continue, and change the wound vacuum canister after admission for residents with these devices, and the facility’s admission assessment policy required the admitting nurse to contact the attending physician, review assessment findings, and obtain admission orders based on those findings, documenting them in the medical record.
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