Cox Medical Centers Meyer Orthopedic And Surgical

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The deficiency involves the facility’s failure to honor a cognitively intact resident’s rights to dignity, respect, and self-determination during wound care to the resident’s left leg. The resident, who was independent with toileting and mobility and care planned as able to participate in treatment decisions, attempted to direct the setup and performance of a complex dressing change. During an observed wound care session, an RN and an LPN from the Skin Wound Ostomy Team entered the resident’s room and the resident immediately began specifying the needed supplies, including multiple disposable pads, a large container, and a 60 ml syringe for saline irrigation. The RN repeatedly disagreed with the resident’s requests, stating fewer pads and less saline were needed, and declined to obtain the large container the resident preferred, despite the resident’s insistence and explanation that the container helped avoid spillage and repeated refilling. As the dressing change progressed, the resident continued to request specific supplies and arrangements, such as four 4x4 gauze pads, additional saline, and placement of a table at the foot of the bed covered with a pad after being dried. The RN and LPN initially ignored or minimized several of these requests, with the RN stating that fewer gauze pads were sufficient and that the large container was unnecessary, and using a smaller sterile container instead. The resident repeatedly asked staff not to begin the procedure until all requested supplies were assembled and to position the table and trash can in particular locations to facilitate the procedure and maintain cleanliness. The RN and LPN partially complied only after multiple requests and at times did so in a manner that suggested they were doing it merely to “make the resident happy,” rather than acknowledging the resident’s right to direct care. The interaction escalated into a power struggle, as described by staff, with the RN openly disagreeing with the resident about the need for the large container and the number of pads and gauze, and the resident expressing frustration, stating that he/she should not have to go through such resistance to have care provided as requested. When additional staff, including the SWOT Manager and another RN, entered the room, the resident objected to having an “entourage” present. The resident continued to direct the technique of irrigation and drying (requesting vertical top-to-bottom motions) and glove changes between steps, and while the SWOT Manager ultimately complied with these directions, she initially attempted to educate the resident rather than immediately honoring the preferences. Interviews with staff afterward confirmed that the RN likely argued with the resident over the container size, that staff consciously chose not to compromise with the resident at first because they did not want the resident to think he/she was “right,” and that the interaction was viewed as a power struggle. Leadership staff stated it was not appropriate for staff to argue with residents and that residents should have their preferences honored within reason, underscoring that the observed conduct did not align with the facility’s own policy requiring residents be treated with respect and dignity and be involved in their care decisions.