cms_WV: 10791
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10791 | MEADOWVIEW MANOR HEALTH CARE | 515141 | 41 CRESTVIEW TERRACE | BRIDGEPORT | WV | 26330 | 2011-08-05 | 280 | D | 1 | 0 | PBEB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on record review, the facility failed to review and revise the care plan of one (1) of seven (7) sampled residents who experienced an acute change in condition with resultant changes in treatment. Resident #14 developed a blister on his left great toe, which was identified in a podiatry consult dated 05/12/11, to which the podiatrist applied a topical antibiotic ([MEDICATION NAME]) and recommended follow-up with the attending physician. On 05/14/11, the attending physician ordered the application of a topical antibiotic and a dressing to the resident's left great toe, but no episodic care plan was developed to address this. On 05/19/11, the attending physician ordered an oral antibiotic (Keflex) four-times-daily to treat "possible infection / [MEDICAL CONDITION]" of the left great toe and foot. An episodic care plan was developed to address an infection to the left great on 05/20/11; this care plan had a discontinuation date of 05/27/11. The resident subsequently developed gangrene (which was diagnosed on [DATE]), and the facility failed to review and revise his care plan to address the deterioration in the status of the resident's toe until 06/14/11, by which time the family asked that he be placed on comfort measures only. Resident identifier: #14. Facility census: 59. Findings include: a) Resident #14 1. Medical record review revealed this [AGE] year old male was most recently re-admitted to the facility on [DATE]. Further record review revealed a podiatry services progress note date 05/12/11, which noted the presence of a blister on the left great toe, to which the podiatrist applied [MEDICATION NAME]; the podiatrist also recorded the need for follow-up by the facility's physician. A box located at the bottom of the form contained a checkmark next to the following statement (quoted as typed): "Based on review of history medical records and exam; this pt (patient) is at medical risk of significant complications and medical care is indicated." -- 2. A review of the resident's physician orders, treatment administration records (TARs), and medication administration records (MARs) found the following: - Order Date: 05/14/11 at 10:00 a.m. (quoted as typed) - "Cleanse lt (left) great toe with dial soap and rinse with NSS (normal sterile saline). Apply [MEDICATION NAME] ointment to toe and cover with a dry dressing." The order was discontinued at 1:50 p.m. on 05/27/11. Documentation on the physician order [REDACTED]. Reeval (re-evaluate). Area is unstageable." - Order Date: 05/20/11 at 6:00 a.m. - Keflex Oral Suspension 250 mg / 5 ml ("Instructions: Great toe on left foot"); give 500 mg by mouth four (4) times daily at 6:00 a.m., 12:00 p.m., 6:00 p.m., and 12:00 a.m. The order was discontinued at 1:47 a.m. on 05/27/11. According to the physician order [REDACTED]. - Order Date: 05/27/11 at 3:00 a.m. - [MEDICATION NAME] Oral Tablet 400 mg, give 1 tab once daily at 8:00 a.m. for "UTI" (urinary tract infection). (Note: Elsewhere in the resident's record, documentation indicated this antibiotic was for a "URI" (upper respiratory infection).) The order was discontinued at 1:00 a.m. on 06/03/11. - Order Date: 06/02/11 at 5:00 p.m. - "TO (telephone order) Arterial ultrasound to Left lower foot Stat, Call office in AM (morning) to get paper faxed." - Order Date: 06/04/11 - "... D/C Skin prep to tip of (lt) gt (great) toe. ..." - Order Date: 06/13/11 at 4:00 p.m. - Keflex 250 mg / 5 ml ("Instructions: gangrene grt (great) lt (left) toe); give 10 cc (500 mg) by mouth four (4) times daily at 6:00 a.m., 12:00 p.m., 6:00 p.m., and 12:00 a.m. This order was discontinued at 4:00 p.m. on 06/20/11. -- 3. Review of the nursing progress notes found an entry, with no date or time recorded but signed by a registered nurse (RN - Employee #11) on 05/20/11, which stated (quoted as typed): "Wound assessment: ... He's also on abt (antibiotic therapy) d/t (due to) [MEDICAL CONDITION] to lt (left) grt (great) toe, no odor or drainage noted. Res (resident) did c/o (complain of) pain when area was tx'd (treated), but he's on scheduled [MEDICATION NAME]. ..." An entry, signed by a licensed practical nurse (LPN - Employee #40) on 05/22/11, stated (quoted as typed): "05/22/11 1642 (4:42 p.m.) Vital signs ... Resident continues on Keflex elixer 500mg po qid r/t (related to) left great toe infection. No s/s of adverse reaction noted. Left great toe is discolored red with yellow drainage observed. Toe is warm to touch. No c/o pain or discomfort noted. ..." Further entries reiterated that Resident #14 was receiving Keflex for an infected left great toe. The next entry that provided a description of the affected area, which had no date or time recorded but was signed by Employee #11 (an RN) on 05/26/11, stated (quoted as typed): "... Res (resident) is on keflex d/t infection to lt grt toe, the tip of toe is blackish / brownish. It's measuring 2.5cmx2.5cm, no odor or drainage, periwound is a pinkish color. Res does yell out in pain when toe is dressed but was already med. (medicated) with a prn (as needed) [MEDICATION NAME]. Once tx (treatment) is finished, res no longer yells out. ..." On 05/26/11, the physician discontinued the Keflex for the infected left great toe and ordered [MEDICATION NAME] to treat an upper respiratory infection. On 05/27/11, the topical antibiotic treatment to the toe was also discontinued, and the twice daily application of skin prep for fourteen (14) days was ordered. After the [MEDICATION NAME] was started, nursing documentation began to focus on the resident's respiratory status, and documentation of the status of the resident's left great toe diminished in frequency with the following entries noted (all quoted as typed): - 05/28/11 at 11:52 a.m. by Employee #62 (an RN) - "... Wound to left great toe, skin prep every day applied. ..." - 05/29/11 at 3:17 p.m. by Employee #11 - "... Res has [MEDICAL CONDITIONS], and the area to lt grt toe could be d/t (due to) that disorder. The area is measuring 0.8cmx2cm and is a dark purplish/brownish area. No odor or drainage noted. The tx of skin prep continues as ordered. ..." - 06/03/11 at 2:30 a.m. by Employee #30 (an LPN) - "... resident has new order for arterial ultrasound of left lower leg stat. ..." - 06/03/11 at 6:21 p.m. by Employee #11 - "Res is on abt d/t infection to lt grt toe, the area is black, no odor or drainage. The outer part of the wound is slightly reddened and a little warm to touch. The area is measuring 2.5cmx2.5cm. He c/ pain when area is touched. He went for ultrasound and per MD and mpoa (medical power of attorney representative) is aware res will be cmo (comfort measures only). ..." - 06/05/11 at 8:23 a.m. by Employee #11 - "Weekly summary: late charting ... Per (name of attending physician) he has gangrene to the lt grt toe, and the family has decided that surgery is not an option for him d/t his overall condition. ..." After the resident was placed on comfort measures only, the family requested another course of antibiotics to treat the infection to the left great toe. On 06/13/11 at 4:53 p.m., Employee #11 recorded the following entry (quoted as typed): "... Res is also to start keflex 250mg/ml 10cc po qid x 7 days per Dr. (name) at mpoa's request. This is d/t gangrene to lt grt toe at this time area remains black but is dry. No odor noted, area is warm to touch. ... " -- 4. Review of the resident's care plans found an episodic care plan, dated 05/20/11, stating (quoted as written): Problem: "Infection great left toe. Goal: "Will resolve during the next 14 days." Approaches: "(1) Antibiotic as ordered. (2) Treatment as ordered. (3) Monitor for improvement or decline of area. Notify MD as needed." This care plan has a "D/C (Discontinuation) Date" of 05/27/11. - There was no evidence that an episodic care plan was developed to address the resident's left great toe on 05/12/11, when the podiatrist identified and treated the blister, or on 05/14/11, when the attending physician ordered the daily application of a topical antibiotic and a dry dressing to the resident's left great toe. The facility also failed to review / revise the resident's care plan to address the need for on-going monitoring of the resident's left great toe and left foot between the date the 05/20/11 episodic care plan was discontinued on 05/27/11 and when the comprehensive care plan was updated on 06/14/11, to note the presence of gangrene and the initiation of comfort measures only. . | 2014-12-01 |