Failure to Revise Care Plans After Changes in Nephrostomy Status and Code Status
Penalty
Summary
The deficiency involves the facility’s failure to revise comprehensive care plans within 7 days of comprehensive assessments and when residents’ conditions or treatments changed. For one resident with hydronephrosis and bilateral nephrostomy tubes, the care plan initiated in mid-February 2025 identified bilateral nephrostomy tubes and included goals and interventions such as monitoring for infection, checking tubing for kinks, monitoring and recording output, and monitoring discomfort. A subsequent hospital discharge summary documented that the left nephrostomy tube was removed and replaced with a stent, and the resident returned with only a right-sided nephrostomy tube. The medical record contained no evidence that the care plan was updated to reflect the removal of the left nephrostomy tube, and the Unit Manager acknowledged that the care plan had not been revised and that this would have been an appropriate time to add interventions such as site cleansing and dressing changes per facility policy. The deficiency also includes a failure to update the comprehensive care plan for another resident who returned from the hospital under hospice care with a change in code status. This resident, admitted with malignant neoplasm of the bronchus or lung, initially had a POLST indicating no decisional capacity and a family election of full code/attempt resuscitation. After hospitalization for acute on chronic hypoxic respiratory failure, the resident returned under hospice care, and a hospice DNR election form documented the family’s agreement to allow natural death and not perform procedures to restart the heart. Despite these changes, the comprehensive care plan was not revised to reflect the resident’s hospice status or the change in code status from full code to DNR. The DON confirmed that the care plan did not reflect these changes, contrary to the facility’s policy stating that assessments are ongoing and care plans are revised as residents’ conditions change.
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