cms_WV: 11514
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 11514 | HEARTLAND OF BECKLEY | 515086 | 100 HEARTLAND DRIVE | BECKLEY | WV | 25801 | 2011-01-07 | 281 | E | XJ0U13 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Based on staff interview, review of "Criteria For Determining Scope of Practice For Licensed Nurses And Guidelines For Determining Acts That May be Delegated or Assigned By Licensed Nurses" (revised 06/17/09), and medical record review, the facility failed to provide goods and services in accordance with professional standards of quality, by assigning a licensed practical nurse (LPN) to complete in-depth skin assessments (including making a determination regarding the staging of pressure ulcers), an act outside her scope of practice. This practice affected one (1) of ten (10) sampled residents (#145) with the potential to affect all residents with pressure sores. The facility also failed to assure that physician orders [REDACTED]. This practice affected one (1) of ten (10) sampled residents (#152) with the potential to affect any other resident with similar physician orders. Resident identifiers: #145 and #152. Facility census: 142. Findings include: a) Resident #145 1. An interview was conducted, on 01/06/11 at 3:40 p.m., with registered nurse (RN - Employee #187) related to the care and services provided to promote healing to former Resident #145. During this interview, Employee #187 requested the assistance of the wound nurse, Employee #127 (who was an LPN). While discussing the interventions that had been put into place for Resident #145, Employee #127 described her contribution to the assessment of pressure ulcers. The LPN reported, at 3:55 p.m. on 01/06/11, that she was responsible for all the pressure ulcers of residents on the A, B, and C units of the facility. She stated she measured the wound beds; identified / described the presence of any tunneling, drainage, and colors; and staged the wounds. When asked if she had received specialized training in the assessment and staging of wounds, Employee #127 stated she did not have any additional credentials such as a wound care specialist. - 2. The administrator was asked, on the afternoon of 01/07/11, for evidence that the LPN (Employee #127) had received training or education in assessing and staging pressure ulcers. The administrator was unable to provide any evidence that this LPN had received formal training beyond entry level. - 3. Review of "Criteria For Determining Scope of Practice For Licensed Nurses And Guidelines For Determining Acts That May be Delegated or Assigned By Licensed Nurses" (revised 06/17/09), which was published jointly by the State's licensing boards for RNs and LPNs, found the following on page 6: "Both the RN and LPN are responsible for implementing the nursing process in the delivery of nursing care. The Boards receive many questions about the LPN's role in the assessment component of the nursing process. While the law does not specifically address the issue of the LPN's role in the assessment process, the rule clearly places the responsibility for the analysis of the data on the RN..." Review of page 12 found a section entitled "Guidelines for Delegation of Nursing Acts To the Licensed Practical Nurse", which contained the following language: "1. Delegation of acts beyond those taught in the basic educational program for the LPN should be based on a conscious decision of the registered nurse. - Practice beyond entry level for the LPN should not be automatic nor should it be based solely on length of experience. 2. Practice beyond entry level must be competency based. - Competency based practice is defined by structured educational activities which include assessment of learning and demonstration of skills. 3. Records of educational activities designed to enhance entry level knowledge, skill and ability must be maintained and available to the RN making the decision. - The employer and the employee must maintain records which include an outline of the educational content and an evaluation of achievement of educational objectives and demonstrated skills..." - 4. An interview with the RN assessment coordinator (Employee #48), who was responsible for the completion of the minimum data set (MDS) assessment, was conducted on 01/07/11 at 5:15 p.m. via telephone. She agreed that she was responsible for completing the pressure ulcer assessment section of each resident's MDS. When asked how she determined the stage of pressure ulcers, she stated she retrieved that information from the facility's weekly wound tool. When asked if she personally assessed resident wounds prior to completing the assessment portion of the MDS and staging the wounds, she stated she did not assess the wounds in order to complete this section of the MDS. - 5. A follow-up interview with Employee #127 was conducted via speaker phone on 01/07/11 at 6:15 p.m., in the presence of the administrator and the director of nursing (DON). Employee #127 verified she completes the weekly wound tool and stages the wounds. When asked if she received assistance in doing this from the RN, she stated, "Very rarely do I have to ask about a wound." -- b) Resident #152 Review of Resident #152's medical record found that, on 12/21/10 at 4:15 a.m., the physician gave the following orders: "Hold pain medications, [MEDICATION NAME], ... [MEDICATION NAME] until BP (blood pressure) comes up. Monitor BP Q (every) 30 minutes." 1. With respect to holding these medications in the presence of low blood pressure, the order did not contain clear and specific instructions to the licensed nurses to indicate when the resident's blood pressure was high enough to prompt the nurses to restart the medications. An interview with the DON, on the afternoon of 01/05/11, confirmed this order should have been clarified by the nursing staff. 2. With respect to the on-going monitoring of the resident's blood pressure, the order did not contain parameters to indicate at what point the licensed nurses were to discontinue monitoring the resident's blood pressure at a frequency of every thirty (30) minutes. Review of the medical record found the licensed nursing staff followed the physician's orders [REDACTED]. . | 2014-01-01 |