cms_WV: 11299
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 11299 | NICHOLAS COUNTY NURSING AND REHABILITATION CENTER | 515190 | 18 FOURTH STREET | RICHWOOD | WV | 26261 | 2010-03-25 | 314 | G | 1 | 0 | 4NN911 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on medical record review, observation, review of Pressure Ulcers in Adults: Prediction and Prevention, Clinical Practice Guideline Number 3, AHCPR Pub. No ,[DATE]: [DATE], and staff interview, the facility failed to ensure two (2) of five (5) residents with pressure sores received the necessary services to promote healing and prevent new sores from developing. Resident #16, who was known to clench her hands, did not receive any services to prevent the development of Stage II and Stage II wounds to her palms caused by her fingernails; additionally, Resident #16's nurse contaminated the resident's coccygeal wound during a dressing change, and a nursing assistant massaged a reddened area over a bony prominence - an action known to cause tissue damage. Resident #59's nurse did not follow the current physician's orders [REDACTED]. Resident identifiers: #16 and #59. Facility census: 87. Findings include: a) Resident #16 1. Review of Resident #16's medical record found a nursing note, dated [DATE] at 10:40 a.m., stating, "Resident observed to have Stage III pressure area to palm of right hand caused by fingernail of third digit of right hand. Area cleansed /c (with) wound cleanser, dried and [MEDICATION NAME] powder applied. Hand roll placed in right hand. Left hand noted to have two 1 cm x 1 cm Stage I pressure areas to inside of fourth digit touching third digit. Also, 0.5 cm x 0.5 cm fluid filled Stage II pressure area noted to palm of left hand caused by fingernail of fourth digit ... Apply [MEDICATION NAME] power /c with hand rolls at all times ... Measurement of Stage III 1.5 cm x 2 cm x 0.5 cm ..." Review of the [DATE] treatment administration record (TAR) found the resident was receiving restorative nursing services to include passive range of motion, three (3) sets of ten (10) repetitions, to bilateral upper and lower extremities including all joints of fingers; these restorative services were originally ordered on [DATE]. The TAR documented the order was discontinued on [DATE]. Review of the care plan, in effect for the time period including [DATE] through [DATE] (when the pressure ulcers were discovered), found no instruction for nursing assistants on the floor to continue the passive range of motion to the resident's fingers, after the restorative nursing services were discontinued, to help prevent pressure-related injury to the resident's hands. The director of nursing (DON - Employee #19) was unable to provide any evidence that passive range of motion to the resident's hands was provided by staff between [DATE] and [DATE] (when the pressure ulcers were discovered to the resident's hands). The medical record contained no instructions or physician orders [REDACTED]. A nursing note, dated [DATE] at 10:40 a.m., documented the presence of "contractures to hands". A nursing note, dated [DATE], stated, "Res (resident's) hands tightly closed in fist position per usual." A nursing note, dated [DATE], documented, "Res hand contracted per usual." Multiple interviews with the DON, on the morning and afternoon of [DATE], could elicit no interventions on the facility's part to prevent the pressure-related injury to the resident's hands after the restorative nursing services were discontinued on [DATE]. 2. Observations of the dressing change to the resident's Stage IV pressure ulcer on the coccyx were conducted at 1:20 p.m. on [DATE]. A licensed practical nurse (LPN - Employee #5) was observed to wash her hands and put on clean gloves. She then placed her right hand into her uniform pocket to retrieve scissors and placed them on the nightstand. She pulled up her pants on the front and on both sides using her gloved hands. She then walked across the room, picked up a roll of trash bags which were on the resident's dresser, obtained one (1) bag, opened it, and placed it at the foot of the resident's bed. Employee #5 then removed the dressing from the resident's coccyx, exposing the open wound. She squirted sterile saline into the wound and reached in with her contaminated gloved fingers to pick out pieces of packing. She repeated this procedure multiple times. Employee #5 contaminated the resident's wound with any bacteria or other infective agents which could have been present in her uniform pocket, the outside of her uniform, or on the trash bags laying on the resident's chest of drawers. 3. Random observations to assure staff was turning the resident were conducted beginning at 2:00 p.m. on [DATE]. Upon entering the resident's room, observation found the resident positioned on her right side with her left hip exposed. The nursing assistant (NA - Employee #98) was observed to be vigorously massaging a reddened area on the resident's left hip. When asked why she was massaging the reddened area, Employee #98 stated, "I'm old school, and that's how we were trained to do it." Review of Pressure Ulcers in Adults: Prediction and Prevention Clinical Practice Guideline Number 3, AHCPR Pub. No ,[DATE]: [DATE], found the following: "4. Massage "Avoid massage over bony prominences. (Strength of Evidence=B.) "Rationale "Massage over a bony prominence has been used for decades to stimulate circulation, contribute to a sense of patient comfort and well-being, and assist in prevention of pressure ulcers. However, the scientific evidence for using massage to stimulate blood and lymph flow and avert pressure ulcer formation is not well established, whereas there is preliminary evidence suggesting that it may lead to deep tissue trauma." b) Resident #59 Review of the medical record, on [DATE], found a physician's orders [REDACTED]. Review of the [DATE] treatment administration record (TAR), on [DATE], found no documentation of a dressing having been applied on [DATE]. Employees #5 (LPN), #74 (NA), and #98 (NA) assisted with an observation of the resident's coccyx at 1:25 p.m. on [DATE]. This observation found no dressing present to the open wound on the resident's coccyx. Employee #5 stated the dressing must have fallen off and she would immediately apply another one. An interview with Employee #5, on [DATE] at 2:45 p.m., revealed she had not followed the current physician's orders [REDACTED]. She stated she utilized the [DATE] physician's orders [REDACTED]. | 2014-07-01 |