Failure to Implement Physician Orders and Care Plan for Edema Management
Penalty
Summary
A deficiency occurred when the facility failed to provide treatment and care according to physician orders and to incorporate that treatment into the resident’s comprehensive care plan. Surveyors observed a resident with swollen bilateral lower extremities; an RN assessed the legs and identified bilateral pitting edema, more prominent in the left lower leg. The resident was described as alert and responsive with periods of confusion, impaired hearing, and slurred speech. Review of the medical record showed the resident had diagnoses including essential hypertension, atrial fibrillation, history of falling, muscle weakness, muscle wasting, unsteadiness on feet, and hearing loss. The active physician order sheet directed staff to apply an ace wrap to the resident’s bilateral lower extremities twice daily for edema, to be applied in the morning and removed in the evening. However, the ace wrap bandages were not applied as ordered, and the comprehensive care plan did not address management of the resident’s edema using ace wrap bandages. When asked, the DON acknowledged that staff should be following the physician’s order and addressing the bilateral lower extremity edema in the care plan. The facility was unable to provide any policy or procedure specific to edema management or the application of ace wrap bandages to the bilateral lower extremities for edema, although it did have general policies on physician orders and care planning.
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