Failure to Follow Physician Orders for Compression Therapy and Edema Management
Penalty
Summary
The deficiency involves the facility’s failure to provide treatment and care according to physician orders and residents’ care plans, specifically related to compression therapy for edema and lymphedema management. One resident with heart failure, history of DVT, and lymphedema had repeated wound NP notes over several weeks stating the need for AeroWrap inelastic compression for all-day wear at 30–50 mmHg for lymphedema management, and the care plan was updated to reflect lymphedema. However, there was no corresponding physician order for AeroWraps or any compression device in the clinical record, and the resident confirmed she did not have compression stockings; observation showed edematous lower legs with sock indentations. Another resident with high blood pressure, heart failure, and diabetes had a care plan intervention for bilateral knee-high TED hose and a physician order to apply ace wraps to both lower extremities. The March treatment administration record (TAR) showed that an LPN documented application of ace wraps on a specific date, but observation that same day revealed the resident did not have the ace wraps on. A third resident with heart failure, atrial fibrillation, and lymphedema had a care plan and physician order for ace wraps to both lower extremities every morning from the base of the toes to one inch below the knee. The March TAR lacked documentation of ace wrap application on multiple dates, and the order was incorrectly scheduled for nighttime instead of morning. During observation, this resident had ace wraps in place with a large amount of blood on the wraps and reported that staff did not always apply them and did not assist with removal despite call light use. A fourth resident with coronary artery disease, atrial fibrillation, and a need for assistance with personal care had a care plan and physician order for bilateral below-the-knee TED hose to be applied in the morning and removed at night. The March TAR indicated an LPN had applied the wraps on a specific date, but observation that afternoon showed the resident was not wearing compression stockings. A fifth resident with Alzheimer’s disease, diabetes, and a need for assistance with personal care had a care plan and physician order for bilateral lower extremity TED hose to be applied every morning and removed at bedtime for edema. The March TAR lacked documentation of application on multiple consecutive days, and although the TAR showed application on a later date, observation that afternoon showed the resident was not wearing compression stockings; when the resident asked an RN how her legs looked, the RN responded that they were swollen as usual. The Nursing Home Administrator confirmed that the facility failed to follow physician orders for five of seven residents reviewed.
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