Failure to Implement Care Plan Interventions for Antiplatelet Therapy and Foley Catheter Care
Penalty
Summary
The deficiency involves the facility’s failure to implement comprehensive care plan interventions for two residents as required by its policy on person-centered care planning. For one resident with diagnoses including hypertension, GERD, type 2 diabetes mellitus, an orthopedic implant with joint prosthesis or bone plate in the left leg, and morbid obesity, the care plan identified that the resident was receiving antiplatelet medication therapy. The care plan interventions included administering the antiplatelet medication as ordered, monitoring the skin for bruising and notifying the physician of new bruising or discoloration, and monitoring and documenting adverse reactions such as blood-tinged or bloody urine, black tarry stools, sudden severe headaches, nausea, vomiting, lethargy, or sudden changes in mental status. The medical record showed an order for Ecotrin (aspirin) 325 mg by mouth twice daily related to a tibia or fibula fracture following insertion of an orthopedic implant, but there was no evidence of a daily monitoring tool in place to track adverse risks associated with the antiplatelet therapy. The deficiency also includes failure to implement care plan interventions for another resident with diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting the left dominant side, morbid obesity, obstructive and reflux uropathy, and hypertension. This resident’s care plan documented the presence of an indwelling Foley catheter related to obstructive uropathy and wounds to the buttocks, with interventions directing staff to change the Foley catheter as ordered and as needed, provide Foley catheter care per facility protocol by cleaning every shift and as needed, and observe for and report signs and symptoms of infection such as elevated temperature, cloudy urine, foul-smelling urine, lower abdominal pain, or changes in cognition. Review of the Treatment Administration Record for a specified month showed multiple days and shifts where there was no documented evidence that daily catheter care was provided as care planned, indicating that the ordered catheter care interventions were not consistently implemented.
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