| 6886 |
OAKS - SCENIC VIEW SKILLED NURSING, THE |
115393 |
205 PEACH ORCHARD ROAD |
BALDWIN |
GA |
30511 |
2013-02-14 |
281 |
D |
0 |
1 |
P02P11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, the facility failed to clarify the parameters for when to administer insulin, and clarify when to use a walking boot for one (1) resident (Q). The facility also failed to clarify a pressure ulcer treatment order and assess a residents skin condition after the removal of a cast for one (1) resident (#270). The sample size was thirty-three (33) residents. Findings include: 1. Review of resident Q's physician's orders [REDACTED]. Further review of the order revealed it did not specify how much insulin to give if the FSBS exceeded 353. Review of resident Q's Medication Administration Records (MAR) revealed that the blood sugar exceeded 353 on 12/19/12; 01/16/13; and 02/09/13. Further review of the MAR indicated [REDACTED]. During interview with Registered Nurse (RN) Unit Manager DD on 02/14/13 at 8:40 a.m., she stated that the nurse that did the FSBS should have contacted the physician when the blood sugar exceeded 353, as there was no order for insulin coverage above that. Cross-refer to F 309. 2. Review of an orthopedic physician's orders [REDACTED]. Walker boot to right lower leg. Diagnosis: [REDACTED]. Further review revealed the order did not specify when the resident was to wear the boot. On 02/13/13 at 8:55 a.m., Licensed Practical Nurse (LPN) Treatment Nurse BB was observed performing a dressing change to an open blister to resident Q's right outer ankle. During interview, LPN BB stated the wound was found on 02/09/13, and was caused by the velcro walking boot. During interview with LPN CC at 9:15 a.m., she stated that they continued to apply the walker boot after the blister was discovered, but that they had covered the wound with a protective dressing. Review of a Grievances/Complaint Form dated 02/09/13 revealed that a complaint was filed by a family member of resident Q which noted that the resident had their boot on all night. Review of the Action Taken section of the complaint noted that when the problem was identified on Saturday (02/09/13) to be causing irritation, it (the boot) was removed. Review of an untimed Nurse's Notes (NN) dated 02/09/13 noted the boot be in place for transferring and when out of bed and that the boot to remain off at night. Review of the 10:00 p.m. NN on this date revealed that the brace to right foot was intact. During interview with LPN BB on 02/13/13 at 3:30 p.m., she stated the order for the walking boot was not very clear as far as when it was supposed to be worn. Upon further interview she added that walking boots were usually worn just for transfers. During interview with Occupational Therapist (OT) EE on 02/14/13 at 8:25 a.m., she verified the order did not specify whether the boot should be worn continuously, or only when out of bed. During interview with Unit Manager DD at 8:30 a.m., she stated there was no documentation in the NN as to when the boot was delivered and/or applied; that they did not even receive the order for the boot until 02/13/13; and that the order should have been clarified as to how often to wear the boot. During interview with LPN CC at 9:03 a.m., she stated that when she came to work on 02/09/13, she received resident Q in bed early that morning, and that the boot was on. Upon further interview, she stated she removed the boot after receiving the family complaint about the boot being left on all night, and discovered the blister on the resident's right ankle at that time. She verified documentation in the NN that the boot was on at 10:00 p.m. later that night. LPN CC further stated that she tried to clarify the order for when to wear the boot on 02/09/13, but that the orthopedic doctor's office was closed. During interview with Physical Therapist (PT) FF on 02/14/13 at 9:35 a.m., she stated that she applied the walking boot on 02/07/13, and instructed the nursing staff to remove it when the resident went to bed. Upon further interview, she verified the order for the walking boot did not specify when to wear it, but felt it was for protection of the resident's fractured ankle during transfers. During interview with the RN Nurse Consultant GG at 10:45 a.m., she stated she would expect for nursing to follow the physician's orders [REDACTED]. Cross-refer to F 314. 3. Resident # 270 was admitted to the facility on [DATE] 13 with a [DIAGNOSES REDACTED]. Review of the Daily Nurses Notes indicated the resident went to the physician's office on 2/8/13. Further review indicated the cast on the right foot was removed at the physician's office. The resident returned to the facility with orders to for skin care to the right ankle, foot and calf. There was no evidence in the medical record of an assessment of the right foot and leg upon return from the physician's office on 2/8/13. Review of the Daily Skilled Nurses Notes dated 2/9/13 indicated the resident complained of pain to the ankle. The boot was removed and a reddened area was noted to the inside ankle and outside bone of the right ankle. A dark area was noted to the top of the foot. The note indicated the boot was loosened and notation was made that area was to be monitored. Review of the medical record indicated no evidence of any additional assessment of the areas on the right foot and ankle and no evidence any type of treatment was performed to the area. During an interview on 2/13/13 at 3:00 p.m. Licensed Practical Nurse (LPN) BB Stated she did not remove the boot after the resident returned from the physician on 2/8/13. She further confirmed she did not call the physician to clarify the instructions to perform skin care to the right ankle foot and leg twice a day. Review of the Georgia State Nurse Practice Act, Article II, Chapter two, Section 3.2 revealed the responsibility for Nursing Practice Implementation. The Licensed Practical Nurse [MEDICATION NAME] under the direction of a Registered Nurse, Advanced Practice Registered Nurse, Licensed Physician or other authorized licensed health care provider: A. Conducts a focused nursing assessment, which is an appraisal of the client's status and situation at hand that contributed to ongoing data collection. B. Plans for episodic nursing care. C. Demonstrates attentiveness and provides client surveillance and monitoring. D. Assists in identification of client needs. E. Seeks clarification of orders when needed During an interview on 2/14/13 at 9:15 am the Director of Health Services (DHS) stated the expectation would be for the nurse to notify the physician for verification of the orders for the treatment and the nurse should have assessed the area upon return to the facility after the cast had been removed. Cross Refer: F314 |
2017-09-01 |