Failure to Provide Timely Medical Response, Wound Management, and Ordered Daily Weights
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate medical treatment and timely response to a change in condition for a resident with hematuria and anemia, as well as failures in wound care management and completion of ordered daily weights for other residents. One resident with acute kidney failure, urinary retention, and a Foley catheter had ongoing hematuria and blood clots while receiving Eliquis. Laboratory results showed low red blood cell and hemoglobin levels, and nursing notes documented large blood clots and bloody drainage from the penis on multiple occasions. Although nursing staff paged the nurse practitioner and notified the urologist, there were significant delays in response to the change in condition, and the medical record lacked evidence of timely family notification. The resident continued to receive Eliquis through multiple days of documented bleeding and low hemoglobin until an order was finally obtained to hold the anticoagulant and repeat labs, after which a critically low hemoglobin prompted transfer to the emergency department. Another deficiency involved a resident admitted with a displaced right femur fracture and right hip arthroplasty who had a dressing to the right hip but no corresponding wound care orders or care plan interventions. Observation confirmed the presence of a right hip dressing without any documented wound care orders in the medical record. The DON confirmed that the resident did not have orders or a care plan for wound care and interventions related to the right hip surgical site, despite the presence of a dressing. A further deficiency concerned a resident with a history including surgical aftercare for digestive system surgery, muscle weakness, and malignancies of the liver and colon, who had a documented stage 4 pressure ulcer but also had an additional skin tear on the left posterior inner thigh. The quarterly MDS did not reflect the skin tear, and the physician orders contained no assessments or treatments for this wound. During wound care observation, a dressing dated several days earlier was noted on the left posterior inner thigh, and the DON confirmed that the medical record did not contain documentation of or orders to treat this skin tear, contrary to the facility’s wound care policy requiring verification of physician orders for wound procedures. Additionally, the facility failed to obtain daily weights as ordered for another resident with morbid obesity, type II diabetes mellitus, and cardiac-related monitoring needs. This resident had an order for daily weights and a care plan that included monitoring for edema and obtaining vital signs as ordered. Review of treatment administration records showed multiple missed daily weights in both February and March, with no documentation in the progress notes explaining why the weights were not completed. An LPN confirmed that some of the required daily weights had not been obtained as ordered, despite the facility’s policy that residents’ weights be monitored and recorded in the electronic medical record to evaluate nutritional status within the parameters of their medical condition.
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