cms_WV: 130
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 130 | HUNTINGTON HEALTH AND REHABILITATION CENTER | 515007 | 1720 17TH STREET | HUNTINGTON | WV | 25701 | 2017-09-07 | 353 | E | 0 | 1 | QLZ111 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, resident interview, policy review, and observation, the facility failed to ensure qualified nursing staff provided day to day care to meet the resident's needs in an environment which promoted each resident's physical, mental, and psychosocial well-being, to enhance their quality of life. The facility failed to ensure all employees were thoroughly screened prior to employment (Employee #150 was not screened through West Virginia (WV) Cares as required by law.) For Residents #322, #372, #280, #84, #110, #233, #290 and #367's allegations of abuse/neglect was not thoroughly investigated and reported to the appropriate state agencies. For Resident #235, the facility failed to follow physician orders [REDACTED]. For Resident #141, the facility failed to follow physician orders [REDACTED]. For Residents #284 and #336 the facility failed to assess pressure ulcers present on admission. For Resident #382, the facility failed to correlate care and services for a resident receiving [MEDICAL TREATMENT] treatments. For Resident #19, the facility failed to follow physician's guidance to contact the responsible party in regard to completing lab tests. For Resident #19, the facility failed to provide restorative services as ordered by the physician. For Resident #90, the facility failed to have the knowledge needed to provide oral care for a dependent care resident. For Residents #141 and #320, the facility failed to provide the necessary services for each resident to restore and/or maintain the resident's bladder functioning. For Residents #350 and #214, the facility failed to ensure the residents environment was as free of accident hazards as possible. For Resident #320, the facility failed to ensure acceptable parameters of nutrition was maintained. For Resident # 350, the facility failed to administer insulin as ordered. These deficient practices had the potential to affect more than an isolated number of residents. Employee identifier: #150. Resident identifiers: #322, #372, #280, #84, #110, #233, #290, #367, #235, #141, #284, #336, #382, #19, #90, #320, #214, #350 and #320. Facility census: 180. Findings include: a) Resident #382 A review of the information submitted by the facility regarding how many residents in the facility received [MEDICAL TREATMENT] treatment revealed Resident #382 received [MEDICAL TREATMENT] on Tuesday, Thursday and Saturday. The physician's orders [REDACTED]. The physician's orders [REDACTED]. On 08/31/17 at 10:05 a.m. Licensed Practical Nurse (LPN) #111 said she was not sure what days the resident attended [MEDICAL TREATMENT] but thought she went in the evening. A second conversation, with LPN #111 on 08/31/17 at 10:37 a.m., revealed LPN #11 felt the resident's [MEDICAL TREATMENT] time slots varied and sometimes she went in the morning and sometimes in the evening. LPN #111 said it depended on whether or not the [MEDICAL TREATMENT] center had a seat for the resident in the mornings. She said they would call in the mornings and let the facility know if the resident could attend in the morning instead of the evening. LPN #111 said they mostly called before 9:00 a.m. A progress note, dated 09/05/17, stated the resident's regularly scheduled time for [MEDICAL TREATMENT] would be Monday, Wednesday, Friday but was subject to change based on the [MEDICAL TREATMENT] center availability. On 08/31/17 at 11:07 a.m. Resident #382 said she had called the dietary department to make sure she got a meal tray at 5:00 p.m. everyday just to make sure she would get it early on the days she attends [MEDICAL TREATMENT]. On 08/31/17 at 11:07 a.m., during an interview with Resident #382, the resident explained that the facility was not doing a very good job regarding the coordination of her care. She said a nurse aide came on the morning of 08/31/17 and asked her if she was ready to get dressed for [MEDICAL TREATMENT]. She said she reminded the nurse aide that she did not attend [MEDICAL TREATMENT] on Thursdays. Resident #382 also said she had concerns over showering because she did not think she could get her Permacath (special catheter inserted in the jugular vein on the neck or upper chest area to aid in [MEDICAL TREATMENT]) wet. She said staff members felt they could cover up the Permacath and give her a shower. On 08/30/17 at 10:00 a.m., during a confidential interview with a registered nurse (RN), the RN said she was not sure if the Permacath could be covered for showering. She also said she was not positive if there were any medications she could not give prior to [MEDICAL TREATMENT]. The RN said she thought she might not be able to give the blood pressure medications prior to [MEDICAL TREATMENT]. Nurse Aide #145, on 08/30/17 at 10:10 a.m., said she thought you could cover the Permacath with a plastic type covering and give the resident a shower. A progress note dated 09/05/17 stated, Due to Permacath, resident should not receive showers and only bed baths should be given The note also indicated that all medications could be given prior to [MEDICAL TREATMENT] with no concerns. 09/05/17 Note Text: Spoke with Debra at [MEDICAL TREATMENT] center to clarify [MEDICAL TREATMENT] order for resident. The Pre/Post Treatment information sheet from a [MEDICAL TREATMENT] treatment on 08/25/17 was not received by the facility until 08/30/17 at 12:06 p.m. Licensed Practical Nurse (LPN) #103 was asked about the Pre/Post [MEDICAL TREATMENT] treatment sheet for 08/25/17 on 08/30/17 at 11:44 a.m. LPN #103 said the [MEDICAL TREATMENT] treatment center did not send this sheet back on 08/25/17 and he had requested they fax it to the facility. He said he was not sure who may have requested it before he did. On 09/05/17 at 12:12 p.m. during an interview with Assistant Director of Nursing (ADON) #40 it was explained that the nursing staff did not have good coordination with the [MEDICAL TREATMENT] center regarding the care for Resident #382. The issues with the confusion over which days and and what time the resident went to [MEDICAL TREATMENT] was discussed as well as the issues with the Permacath, medications and dietary. Following the interview with the ADON, RN #87 telephoned the [MEDICAL TREATMENT] center. The following note was recorded in the resident's medical record, Spoke with (staff name) at [MEDICAL TREATMENT] center to clarify [MEDICAL TREATMENT] order for resident. (Staff name) confirmed that her scheduled time is to be MWF at 1800 but is subject to change based on center's availability. (Name of ambulance company) to transport to all appointment times. (Staff name) also said that all medications could be given prior to the resident arriving at [MEDICAL TREATMENT] with no concerns. Also, due to Permacath, resident should not receive showers and only bed baths should be given. Resident is aware of the above and agrees with all b) Resident #19 On 07/17/17 a laboratory specimen for a renal panel was collected per the physician's orders [REDACTED]. The results of the specimen were reviewed by the physician on 07/17/17. The results indicated the following abnormalities: Sodium was high, Chloride was high, BUN (blood Urea Nitrogen) was high, Glucose was high and Calcium was low. The physician ordered a no added salt diet and directed staff to encourage oral fluids, after reviewing the laboratory results. The physician advised the nurse to contact the resident's responsible party to determine if the responsible party wants repeated laboratory reports. Further review of the resident's Physician order [REDACTED]. Under the heading, Medically Administered Fluids and Nutrition, No Labs, had been hand written under the category of other orders. A straight line had been drawn through, No Labs, and above was hand written D/C 05/20/15. The POST form was unclear as to if the responsible party wanted or did not want any laboratory values drawn. The Director Of Nursing reviewed the laboratory report and the POST form at 10:10 a.m. on 08/30/17. She said she would follow up with the unit manager, Registered Nurse (RN) #116 to see if she contacted the responsible party. At 12:06 p.m. on 08/30/17, the DON said she was unable to find any evidence the responsible party was contacted in regards to obtaining future laboratory values. c) Resident #284 Resident #284 was discharged from the facility to an outside hospital on [DATE] due to lethargy and a general decline in his condition. At the time of his discharge, Resident #284 had a stage IV pressure ulcer on his right heel. He also had a surgical wound on his coccyx where a skin flap procedure had been performed. Resident #284 returned to the facility on [DATE]. The Nursing Admission Data Collection, performed on 08/26/17 at 8:26 p.m., documented the presence of a wound on the back of his right lower leg, in addition to the coccyx wound and the right heel pressure ulcer that were present upon discharge. No description of the right lower leg wound, including measurement and staging, was documented. On 08/28/17 at 5:11 p.m., a Skin - Weekly Pressure Ulcer Record evaluation was performed. A new right lateral calf pressure ulcer was documented. The date of onset was given as 08/26/17, and the pressure ulcer was noted to have been present since admission. The pressure ulcer was described as a Stage III with measurements of 3 cm x 3.2 cm x 1 cm. The wound base was noted to be 100% yellow tissue. Because the right lower leg pressure ulcer had not been assessed upon admission, it cannot be determined whether the wound worsened from the time of admission on 08/26/17 to the time of assessment on 08/28/17. According to the facility's Skin Management policy and procedure with a revision date of (MONTH) (YEAR), Residents admitted with skin impairments will have wound location and characteristics documented in the Nursing admitted Collection Set (UDA). During an interview on 09/05/17 at 4:42 p.m., the Director of Nursing (DoN) stated wound assessment was not performed by the nurse completing the admission assessment. The wound care nurse performed assessment of wounds and pressure ulcers, including measurement and staging, in order to ensure consistency. Resident #284 was readmitted to the facility on [DATE], which was a Saturday. The wound care nurse was not in the facility on the weekend. The wound care nurse assessed Resident 284's wounds when she returned to the facility on Monday, 08/28/17. The DoN stated the Skin Management policy and procedure with a revision date of (MONTH) (YEAR) was the current policy and procedure. d) Resident #336 Medical record review, on 09/06/17 at 11:10 a.m., for Resident #336 revealed she was admitted on [DATE] after a hospitalization . Review of the Nursing Admission Data Collection Form, indicated the resident had open areas on her coccyx, left, and right buttock. No measurements or description of the open areas could be found. On 05/20/17 at 1:54 a.m., a Nursing Initial care Plan was completed. This care plan found a focus Potential breakdown. Goal: Resident's skin will remain intact without signs of breakdown by next review. Interventions included, Provide wound care/preventative skin care per order and Skin checks weekly per facility protocol, document findings. Review of daily skilled note on 05/20/17 at 3:55 p.m., revealed no skin issues documented. Additional medical record review found initial pressure ulcer record dated 05/22/17 at 1:47 p.m., which revealed Resident # 336 had a total of three (3) pressure ulcers as follows: --Left buttocks- unstageable and measured 4 centimeter (cm) in length and 4 cm in width, depth unknown due to 50% of yellow tissue and 50% purple tissue in wound base. --Coccyx-unstageable and measured 2 cm in length and 1.5 cm in width, depth unknown due to 75% red tissue and 25% purple tissue in wound base. --Right buttocks- unstageable and measured 1.5 cm in length and 1.5 cm in width , depth unknown due to 30% red tissue, 30% yellow tissue and 40% purple tissue in wound base. Physician orders [REDACTED]. During an interview with the Director of Nursing (DON) on 09/07/17 at 12:15 p.m., she verified there was not any documentation by the nursing staff concerning the size, staging and treatments for the resident's pressure ulcers until 05/22/17, three (3) days after admission to the facility. She reviewed the chart and confirmed even though no measurements, staging and treatments were written, the facility claimed the three (3) pressure ulcers were present on admission. She also confirmed there was no documentation to show if the pressure ulcers had changed since admission on 05/19/17. e) Resident #235 1. Aspirin A review of Resident #235's medical record at 9:44 a.m. on 09/06/17 found the following physician order [REDACTED]. Increase ASA (Aspirin) dose to 325 mg (milligrams) 1 po (by mouth) qd (every day) for PE (pulmonary embolism). CBC (completed blood count) 1 wk (week). Review of Resident #235's Medication Administration Record [REDACTED]. In fact Resident #235 has received Aspirin 81 mg daily since 01/05/17 with no change in dosage. An interview with the interim Director of Nursing (DON) at 2:41 p.m. on 09/06/17 confirmed Resident #235's aspirin dose was never increased as the physician order [REDACTED]. 2. Pain Management A review of Resident #235's medical record at 9:44 a.m. on 09/06/17 found the following physician note dated 02/21/17 which read under the section titled, Plan: For Chronic pai[DIAGNOSES REDACTED] continue biofreeze . Further review of the record found a physician order [REDACTED]. This order has remained in effect since 01/09/17 it was revised on 03/29/17 to read as follows: Biofreeze Liquid (Menthol(Topical [MEDICATION NAME]) Apply to bilateral legs topically every four (4) hours for pain. An interview with Resident #235 and her husband at 12:30 p.m. on 09/06/17 revealed Resident #235 often experiences pain in her legs and her feet. When asked what helps with the pain she stated, Biofreeze helps the most. She continued, But I don't always get it like I am supposed to and my legs and feet will hurt. She stated, When I have the biofreeze I do not have to ask for pain medication because the biofreeze takes care of my pain. Review of the Treatment Administration Record (TAR) from 02/01/17 through 09/05/17 found the following days and times when Resident #235 did not receive her biofreeze. Unless otherwise noted the MAR indicated [REDACTED] --02/02/17 at 12:00 a.m. and 4:00 a.m. --02/04/17 at 12:00 a.m. and 4:00 a.m. --02/05/17 at 4:00 a.m. --02/08/17 and 02/09/17 at 12:00 a.m. and 4:00 a.m. --02/12/17 at 12:00 a.m., 4:00 a.m., 8:00 a.m. and 12:00 p.m. --02/13/17 at 4:00 p.m. and 8:00 p.m. --02/14/17 at 12:00 a.m. and 4:00 a.m. --02/15/17 at 12:00 a.m., 4:00 a.m., 4:00 p.m. and 8:00 p.m. --02/17/17 at 12:00 a.m., 4:00 a.m., and 8:00 p.m. --02/18/17 at 12:00 a.m. and 4:00 a.m. --02/19/17 at 4:00 p.m. and 8:00 p.m. --02/21/17 at 12:00 a.m. and 4:00 a.m. --02/24/17, 02/25/17, and 02/26/17 at 4:00 p.m. and 8:00 p.m. Unless otherwise noted the MAR indicated [REDACTED] --03/03/17 at 12:00 a.m. and 4:00 a.m. --03/08/17 and 03/10/17 at 8:00 p.m. --03/11/17 at 12:00 a.m. and 4:00 a.m. --03/13/17 at 4:00 a.m. --03/14/17 at 8:00 p.m. --03/16/17 at 8:00 a.m. and 12:00 p.m. --03/18/17 at 4:00 a.m. --03/19/17 at 12:00 p.m. --03/20/17 at 8:00 a.m. and 12:00 p.m. --03/21/17 at 12:00 a.m. and 4:00 a.m. --03/25/17 at 8:00 p.m. --03/27/17 at 4:00 p.m. and 8:00 p.m. --03/29/17 at 4:00 a.m., 4:00 p.m., and 8:00 p.m. --03/30/17 at 12:00 a.m. and 4:00 a.m. --03/31/17 at 8:00 a.m. and 12:00 p.m. Unless otherwise noted the MAR indicated [REDACTED] --04/01/17 at 8:00 p.m. --04/03/17 at 4:00 p.m. and 8:00 p.m. --04/04/17 at 4:00 a.m., 8:00 a.m., 12:00 p.m., 4:00 p.m. and 8:00 p.m. --04/14/17 at 8:00 a.m. and 12:00 p.m. --04/15/17 at 4:00 a.m. --04/16/17 at 12:00 a.m., 4:00 a.m., 4:00 p.m. and 8:00 p.m. --04/17/17 at 8:00 p.m. --04/18/17 at 12:00 a.m., 4:00 a.m., 8:00 a.m., and 12:00 p.m. --04/22/17 at 12:00 a.m. and 4:00 a.m. --04/23/17 at 12:00 p.m., 4:00 p.m. and 8:00 p.m. --04/24/17 at 12:00 a.m. and 4:00 a.m. Unless otherwise noted the MAR indicated [REDACTED] --05/04/17 at 12:00 p.m. --05/08/17 at 8:00 p.m. --05/13/17 at 8:00 p.m. --05/19/17 at 8:00 a.m. and 12:00 p.m. --05/20/17 at 12:00 p.m. --05/21/17 at 4:00 a.m. --On 05/22/17 at 12:00 a.m., 4:00 a.m., 8:00 a.m., and 12:00 p.m. Progress notes indicated the Biofreeze was not available and they were awaiting its arrival. --05/27/17 at 4:00 a.m., and 8:00 p.m. --Resident was in the hospital from 05/29/17 through 06/05/17. Unless otherwise noted the MAR indicated [REDACTED] --06/10/17 at 4:00 a.m. and 8:00 p.m. --06/11/17 at 8:00 p.m. --06/14/17 at 4:00 a.m., 8:00 a.m. and 12:00 p.m. --06/15/17 at 4:00 a.m. Unless otherwise noted the MAR indicated [REDACTED] --07/05/17 ay 8:00 p.m. --07/10/17 at 4:00 p.m. and 8:00 p.m. --07/14/17 at 4:00 p.m. and 8:00 p.m. --07/26/17 at 4:00 p.m. and 8:00 p.m. --07/30/17 at 4:00 a.m. Unless otherwise noted the MAR indicated [REDACTED] --08/02/17 at 4:00 a.m. --08/08/17 at 4:00 p.m. --08/26/17 at 4:00 a.m. During an interview with the Interim DON at 2:41 p.m. on 09/06/17, the above findings were reviewed with her. She indicated that they appear to have a documentation problem and that the TAR should not be left blank. She stated it should have a check mark or a code number indicating why the treatment was not administered. f) Resident # 141 A review of Resident #141's medical record at 8:41 a.m. on 08/31/17 found the following physician order [REDACTED]. Review of the Medication Administration Record [REDACTED]. For the [MEDICATION NAME] the MAR indicated [REDACTED]. Review of the progress note dated 05/27/17 at 4:58 p.m. indicated the medication was not administered because they were awaiting its arrival from the pharmacy. An interview with the Interim DON at 11:27 a.m. on 08/31/17 confirmed Resident #141 did not receive the ordered dose of [MEDICATION NAME]. She indicated that she called the pharmacy and it was delivered to the facility on [DATE] at 7:08 p.m. but the nurse had already entered the note and there was no indication in the medical record that the medication was ever administered to Resident #141. g) Resident #19 On 08/22/17, the physical therapist referred the resident to the facility's restorative program. On 08/24/17, the resident began the following restorative program: The goal for restorative therapy was: Maintain strength and functional mobility level Activities to be performed for restorative: 1. Stretching to Bilateral hamstrings and bilateral gastrocnemius muscles 30-45 second hold. (MONTH) do in seated or supine position 2. Therapeutic exercises for bilateral lower extremities ankle pumps, heel slides straight leg raises, hip abduction/adduction and hip flexions long arc quads, 2 sets of 10 reps; may do in seated or supine. 3. Wheel chair mobility 50-100 feet Bilateral upper extremities and bilateral lower extremities for propulsion, min Assistance to SBA (stand by assistance); instruct patient on safe turning of wheel chair, safe negotiation of obstacles and correct upper extremity and lower extremity placement. At 2:19 p.m. on 08/30/17, the unit manager, Registered Nurse (RN) #116 said the restorative aides keep paper documentation of restorative services provided to residents. RN #116 said the resident had not received any therapy and she did not know why. RN #116 called Restorative Aide (RA) #33 to review the restorative therapy services. RA #33 said the resident had not had any therapy because a second aide who normally works this floor had not been working due to an injury. RA #33 said she had not been on this floor since last Thursday because she had been pulled to the floor to work as a nursing assistant. At 12:50 p.m. on 09/05/17, RN #116 was asked if the second restorative aide had returned to work. She said the RA was in the dining room today. An interview with the second RA #42 at 1:05 p.m. on 09/05/17, found he was in the dining room assisting with lunch. RA #42 said he was on light duty so he would not be able to work with Resident #19. At 1:10 p.m. RA #33 said she worked the floor yesterday so she did not get to see the resident. She stated, I last saw her on 08/31/17 and she refused her therapy. The resident was seen only one (1) time between 08/24/17 and 08/31/17. The resident had not received restorative therapy during the month of September, according to RA #33. The DON confirmed, Resident #19 was not receiving her restorative therapy as ordered on [DATE] at 4:17 p.m. after review of the Rehabilitation/Restorative Service Delivery Record. At 4:17 p.m. on 09/05/17, the administrator confirmed RA #42 was injured on the job, sometime last week. h) Resident #90 Observation of the resident's oral cavity at 10:41 a.m. on 08/29/17, found the resident had what appeared to be her own teeth. Some were missing, discolored and were covered with a white, chalky substance that appeared to be plaque. Observation of the resident's oral cavity with the Registered Nurse (RN) unit manager, at 12:57 p.m. on 09/05/17, found RN #116 discovered the resident had an upper partial and, What looks like a cavity on the lower back tooth. The resident said she had a partial. She stated, I am not going to show it to you because you might steal it. Three (3) nursing assistants (NA's) #47, #5 and #58, (all working on the resident's unit) and RN #116 denied knowing the resident had a partial at 1:21 p.m. on 09/05/17. All denied removing the partial for cleaning. RN #116 was asked if she could find any evidence the facility was ever aware the resident had a partial or any documentation the partial had been removed for cleaning. Record review found the resident was admitted to the facility on [DATE]. The most recent minimum data set (MDS), a quarterly, with an assessment reference date (ARD) of 06/29/17 notes the resident requires extensive assistance of 1 staff member for personal hygiene, which includes brushing teeth. Review of the last 3 nursing monthly assessments, dated 06/12/17, 07/12/17, and 08/12/17 noted the resident has her own teeth under the section entitled, Dentition. The form also allowed the nurse completing the assessment to note the resident had a Partial(s) Bridge(s). This section was not completed, indicating the resident did not have a partial. At approximately 3:00 p.m. on 09/05/17, the Registered Nurse (RN), Resident Care Manager, #3, provided a progress note from a local dentist. She said the family had requested a dental appointment during the resident's care plan meeting. She said the resident did not cooperate and a follow up appointment was going to be scheduled when the family could attend. She said this was the only dental consult she could find for the resident. The dental consult, dated 08/02/17 noted: Patient barely opened mouth for exam. Patient states she does wear a partial on the MX (maxillary) however was unable to have her remove it. There was gross amount of plaque present. Patient will require [MEDICATION NAME] and a more comprehensive exam. Review of the resident's MDS Kardex Report for the nursing assistants found documentation an upper partial had been added to the Kardex on 09/05/17. At 4:16 p.m. on 09/05/17, the Director of Nursing confirmed she had no further information to present regarding the resident's oral status. i) Resident #320 Review of Resident #320's medical record at 8/30/17 at 12:25 p.m., found: MDS Findings: Section H' Bladder and Bowel 4/29/17: H0300. Urinary Continence: *2. Frequently Incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent-voiding) 5/8/17: H0300. Urinary Continence: *2. Frequently Incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent-voiding) 5/22/17: H0300. Urinary Continence: 3. Always Incontinent (no episodes of continent voiding) 6/17/17: H0300. Urinary Continence: *2. Frequently Incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent-voiding) 7/22/17: H0300. Urinary Continence: 3. Always Incontinent (no episodes of continent voiding) Review of Braden Scale for Predicting Pressure Sore Risk: 04/22/2017 at 2:18 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 3. Occasionally Moist: Skin is occasionally moist, requiring an extra linen change approximately once a day. (3 pts.) 04/25/2017 at 4:24 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 1. Constantly Moist: Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned. (1 pt.) 05/02/2017 at 4:24 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 2. Very Moist: Skin is often, but not always moist. Linen must be changed at least once a shift. (2 pts.) 05/09/2017 at 4:24 p.m. 2. Moisture: Degree to which skin is exposed to moisture: 3. Occasionally Moist: Skin is occasionally moist, reqiring an extra linen change approximately once a day. (3 pts.) 06/16/2017 at 9:43 a.m. 2. Moisture: Degree to which skin is exposed to moisture: 3. Occasionally Moist: Skin is occasionally moist, reqiring an extra linen change approximately once a day. (3 pts.) A Verbal physician's orders [REDACTED]. Confirmed by Employee #1. The above order was discontinued by telephone on 05/05/2017 at 3:08 p.m. Confirmed by Employee #81. A Telephone physician's orders [REDACTED].#81. Review of Treatment Administration Record 05/01/2017-05/31/2017 included the following: Cleanse bilateral buttocks, coccyx, and sacrum with warm soapy water, rinse, pat dry, apply [MEDICATION NAME] cream topically and prn every shift for increased risk for skin break down. -Order Date 04/25/2017 at 4:33 p.m. -D/C Date 05/05/2017 at 2:55 p.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically every shift. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Wash coccyx with warm, soapy water, rinse, pat dry, apply [MEDICATION NAME] q shift and prn every shift for prevention. -Order Date 04/22/2017 at 6:59 p.m. -D/C Date 05/05/2017 at 3:08 p.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Review of Treatment Administration Record 06/01/2017-06/30/2017 included the following: Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically every shift. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Review of Treatment Administration Record 07/01/2017-07/31/2017 included the following: Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry-apply [MEDICATION NAME] cream topically every shift. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically every shift. -Order Date 07/10/2017 at 8:18 p.m. Cleanse scrotum with warm soapy water, rinse, pat dry, and apply [MEDICATION NAME] every shift. -Order Date 07/01/2017 at 5:03 a.m. -D/C Date 07/10/2017 at 8:17 a.m. Cleanse bilateral buttocks, coccyx and sacrum with warm soapy water. Rinse and pat dry -apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 05/05/2017 at 2:55 p.m. -D/C Date 07/10/2017 at 8:18 a.m. Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 07/10/2017 at 8:18 p.m. Review of Treatment Administration Record 08/01/2017-08/31/2017 included the following: Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically every shift. -Order Date 07/10/2017 at 8:18 p.m. Cleanse bilateral buttocks, coccyx, scrotum, and sacrum with warm soapy water. Rinse and pat dry- apply [MEDICATION NAME] cream topically as needed for increased risk for skin breakdown. -Order Date 07/10/2017 at 8:18 p.m. Review of the Nursing Daily Skilled Charting-V 1: (4/22/17, 4/24/17, 4/25/17, 4/26/17, 4/27/17, 4/28/17, 4/29/17, 4/30/17, 5/1/17, 5/2/17, 5/3/17, 5/4/17, 5/5/17, 5/6/17, 5/7/17, 5/8/17, 5/9/17, 5/10/17, 5/11/17, 5/12/17 and 5/27/17) F. GU/BLADDER: 1 b. Bladder Continence: b. INCONTINENT (Total 21 Days) Review of the Nursing Daily Skilled Charting-V 1: (5/13/17, 5/14/17, 5/15/17, 5/16/17, 5/17/17, 5/18/17, 5/19/17, 5/21/17, 5/22/17, 5/23/17, 5/24/17, 5/25/17, 5/26/17, 5/29/17, 5/30/17 and 5/31/17) F. GU/BLADDER: 1 b. Bladder Continence: a. CONTINENT (Total 16 Days) Review of the Nursing Daily Skilled Charting-V 1: (6/9/17,6/12/17, 6/13/17, 6/26/17 and 6/27/17) F. GU/BLADDER: 1 b. Bladder Continence: b. INCONTINENT (Total 5 Days) Review of the Nursing Daily Skilled Charting-V 1: (6/1/17, 6/2/17, 6/4/17, 6/5/17, 6/6/17, 6/7/17, 6/8/17, 6/10/17, 6/11/17, 6/14/17, 6/15/17, 6/17/17, 6/18/17, 6/19/17, 6/20/17, 6/21/17, 6/22/17, 6/23/17, 6/24/17, 6/25/17, 6/28/18, 6/29/17 and 6/30/17) F. GU/BLADDER: 1 b. Bladder Continence: a. CONTINENT (Total 23 Days) Review of the Nursing Daily Skilled Charting-V 1: (7/2/17, 7/3/17, 7/4/17, 7/10/17, 7/17/17, 7/18/17, 7/19/17, 7/20/17, 7/21/17, 7/22/17, 7/23/17, 7/24/17, 7/25/17, 7/26/17, 7/27/17, 7/28/17, 7/29/17 (TRUNCATED) | 2020-09-01 |