Failure to Coordinate Hospice Care and Monitor Non-Pressure Skin Conditions
Penalty
Summary
The deficiency involves the facility’s failure to ensure appropriate treatment and care according to orders, resident preferences, and goals, specifically related to hospice coordination and skin/wound management. One resident with cerebral atherosclerosis, peripheral arterial disease, and adult failure to thrive had a physician order for hospice admission and a care plan noting hospice services and a poor prognosis. However, there was no hospice care plan or visit documentation from hospice nurses or aides in the electronic record, paper chart, or hospice binder. The LPN unit manager stated he did not know when hospice visits occurred or details of the hospice plan of care, and the administrator acknowledged the facility should collaborate with hospice and maintain a copy of the hospice care plan and documentation. The hospice RN confirmed hospice had admitted the resident but had not provided the facility with a care plan or nursing documentation, despite a facility policy requiring communication between the center and hospice to ensure quality care. The facility also failed to provide routine assessment and monitoring for a non-pressure skin condition in a resident with chronic diastolic CHF and stage 3 chronic kidney disease. This resident had a documented nummular eczema rash on the chest, back, arms, and abdomen, with an order for clobetasol ointment twice daily. After an initial assessment and treatment order, there was no further documentation or follow-up on the eczema in the medical record after a specific early December date, even though the clobetasol treatment continued. During an observation of incontinence care, the resident was noted to have multiple red, circular areas of varying sizes on the abdomen, chest, and arms. The LPN unit manager and the regional director of clinical services confirmed there was no nursing follow-up documentation, no weekly skin assessments, and no care plan addressing the nummular eczema. A third deficiency involved another resident with multiple medical conditions, including pain, muscle wasting and atrophy, gait abnormalities, peripheral vascular disease, osteoarthritis, iron deficiency anemia, and hypertension, who had several non-pressure skin impairments. Initial admission assessments documented scabs on both elbows and bruising on the left buttock without measurements, and after a hospital stay for spinal surgery and readmission, an abrasion on the left buttock, a scab on the left heel, and a surgical incision on the back of the neck were noted, with incomplete measurements and descriptions. The DON verified that, aside from the admission assessments, there were no comprehensive assessments or documentation of healing for any of the resident’s skin impairments, even though the resident was followed by a wound clinic. Corporate nursing staff confirmed that facility policy required a licensed nurse to complete a skin observation tool at least every seven days for any wound or skin impairment, and acknowledged that the resident’s non-pressure skin impairments were not assessed weekly by the facility or the wound clinic.
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