| 88 |
PROVIDENCE TRANSITIONAL CARE CENTER |
25018 |
910 COMPASSION CIRCLE |
ANCHORAGE |
AK |
99504 |
2017-06-22 |
309 |
E |
0 |
1 |
NLCD11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview and protocol review the facility failed to ensure 1 resident (#1) received necessary services for: 1) urinary incontinence, 2) pain, and 3) oral care; and 1 resident (#2) received prompt treatment and physician notification after experiencing increased pain after a fall, out of 7 sampled residents reviewed. These failed practices denied residents necessary interventions and services to promote health and well-being and placed them at risk for increased pain and suffering. Findings: Resident #1 Record review on 6/20-22/17 revealed Resident #1 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The Resident was at the facility to receive rehabilitation for an anticipated discharge home. The Resident's medication regime included [MEDICATION NAME] 0.4 mg at bedtime (medication used to improve urination); [MEDICATION NAME] 50mg 2 times a day (medication used for [MEDICAL CONDITION] that is used for neuropathic pain); and Tylenol 325mg 2 tablets every 6 hours as needed for pain. 1) Urinary Incontinence Care Review of most recent Minimum Data Set (MDS-a federally required assessment) admission assessment, dated 5/3/17, revealed the Resident required extensive assistance with transfers and was frequently incontinent of bowel and bladder. Review of the Care Area Assessment (CAA), dated 5/9/17, revealed under type of incontinence Resident #1 was Frequently incontinent of bladder and bowel. Continuous observation on 6/20/17 from 7:20 am until 2:00 pm (6 hours and 40 minutes) revealed the Resident was awake, ate breakfast, went to occupational therapy (OT) and physical therapy (PT), and returned to the unit and ate lunch. The Resident was not offered toileting or checked for incontinence during the observation. During an observation on 6/20/17 at 2:00 pm, Certified Nursing Assistant (CNA) #4 and Licensed Nurse (LN) #4 transferred the Resident into bed. The CNA removed the Resident's incontinence brief which had become saturated with dark foul smelling urine. Both of the Resident's inner buttocks were red and excoriated. Review of Resident #1's Resident Daily Care Plan (RDCP), updated 6/15/17, revealed Toileting: Incontinent of bladder. Continent of bowel. Offer toileting in am, before and after meals, prior to rehab, at HS (bedtime) and PRN (as needed). Review of All Care Plans a comprehensive care plan, dated 5/9/17, revealed a Problem of Altered urinary elimination .as evidenced by Urinary incontinence The Goal included I will be free of skin irritation/ breakdown and odor due to incontinence. The Approach for care referred back to the RDCP. During an interview on 6/20/17 at 2:15 pm, when asked about Resident #1's incontinence care and toileting, CNA #4 replied I try to do it before and after therapy. When asked about today, the CNA replied I was hoping (Resident #1) would be changed in therapy, they do change them sometimes if needed. CNA #4 stated the Resident was already up in a wheelchair when he/she had started work that morning. 2) Pain During an observation on 6/20/17 from 9:50 am until 10:40 am Resident #1 was observed working with OT #2 in the rehab department (located in the same building). During the observation the Resident performed several upper body and extremity movements. As the Resident utilized his/her right hand, the Resident stated Ouch! with a pained expression and ouch that hurts! When crossing both arms the Resident again stated Ouch! When the Resident used the right hand and arm to work at putting rags in a laundry basket the Resident stated Oh, it still hurts! The Resident was frowning and had a pained facial expression. The Resident then picked up and held his/her right hand with the left hand and held it while rubbing it and frowning. During the observation, the OT did not ask the Resident about the pain. Review of the OT Progress Note, dated 6/20/17 at 12:31 pm, revealed no information about the Resident's complaint of pain to the right hand during the session. Review of the electronic Medication Administration Record [REDACTED]. During an interview on 6/20/17 at 1:50 pm, when asked about the [MEDICATION NAME] medication, LN #4 stated Resident #1's morning medications had not been given because the Resident had been at therapy all morning. On 6/20/17 at 1:50 pm LN #4 asked the Resident if he/she was in pain the Resident replied Not now. Review of the MDS assessment, dated 5/3/17, revealed the Resident was on a pain management program and utilized PRN pain medications. The Resident rated the pain as an 8 (very severe), on a scale of 0-10 with 0 being no pain and 10 being the worst pain. Review of the CAA for Pain, dated 5/9/17, revealed pt. states her back teeth are painful, also has c/o (complaints of) pain to RUE (right upper extremity). Review of the All Care Plans, dated 5/9/17, revealed Problem Comfort alteration in pain. The Goal included I will be able to attend PT as scheduled without limitations due to pain. The Approaches included Give meds as ordered, monitor for effectiveness/adverse effects. Review of a MDS Pain Assess/Interview, dated 6/20/17 at 5:48 pm, revealed the Resident rated his/her pain at a 6 (severe) and stated it was in the right hip and back. During an interview on 6/21/17 at 4:00 pm, when asked about the missed medications, Pharmacist #1 stated she/he would have expected the medications to be given before or after therapy. The Pharmacist stated if the am meds were given after 10:30 am they were considered late. 3) Oral Care Record review of Resident #1's MDS assessment, revealed the Resident needed extensive assistance with personal hygiene. Review of the RDCP, revised 6/15/17, revealed Oral Care: 1 person limited assist. Oral care after each meals. (SP) Resident has full upper dentures. During a continuous observation on 6/20/17 from 7:20 am to 2:10 pm, the Resident ate breakfast and lunch in the dining room. The Resident was not provided any oral care after either meal. During an interview on 6/20/17 at 2:15 pm, CNA #4 was asked about the Resident's oral care. The CNA stated the Resident had dentures in the top and a partial in the bottom. The CNA #4 stated he/she does the Resident's denture care in the morning. Resident #2 Record review from 6/19-22/17 revealed Resident #2 was admitted to the facility with [DIAGNOSES REDACTED]. Further review revealed Resident #2 had a fall on 5/19/17 at 9:00 pm. Review of the nurses notes dated 5/20-23/17 revealed: 5/20/17 at 1:53 am - .patient requested Tylenol for left hand pain that (she/he) rated at 4:10. Not related to fall . 5/20/17 at 1:07 pm - .L (left) wrist noted to be slightly larger than .R (right) wrist with limited ROM (range of motion) compared to R wrist as well .Pt was given PRN (as needed) Tylenol for 6/10 pain level in L wrist this morning with good relief noted but pt. (patient) states there was still some pain there. CNA (certified nursing assistant) states that patient has been able to transfer with her today with only mild pain noted to (his/her) L wrist. Note left for MD and supervisor notified. Pt has had increased ROM in her L wrist throughout the day. Ice was applied as well to help reduce swelling . 5/21/17 at 1:01 am - .left hand and wrist has faint indication of being swollen . 5/21/17 at 6:49 pm - .wrist of (his/her) left hand is slightly swollen. No discoloration noticed to the hand. Patient complained of pain, was given a PRN pain medication .Will continue to monitor and assess functionality of the left hand . 5/22/17 at 2:55 am - .Mild swelling noted on L wrist, no bruises noted . 5/22/17 at 10:35 am - .Patient continues with mild swelling to .left hand and wrist area . 5/22/17 at 2:32 pm - .Left .wrist slightly swollen . 5/22/17 at 5:16 pm - . (Tylenol .REASON: pain . 5/10 L[NAME]ATION: left hand(s) . 5/22/17 8:52 pm - . (Tylenol) .given for pain .7/10 L[NAME]ATION: left arm(s) wrist(s) . 5/23/17 at 2:25 pm - . (Tylenol) .pain .5/10 L[NAME]AION: both arm(s) shoulders (s) . Review of the Physical Therapy (PT) note: 5/21/17 at 8:00 am revealed .left wrist appears to have some swelling on ulnar (outer) side. Review of the physician's orders [REDACTED].>5/21/17 at 2:39 am - .Icing as needed .GIVEN FOR: Left wrist slight swelling. 5/22/17 at 2:39 pm - .Imaging Requisition Report .Xr (x-ray) Wrist Left 2 (view) .Diagnosis: [REDACTED].status [REDACTED]. 5/23/17 at 11:39 pm - .splint brace L[NAME]ATION: Left wrist .GIVEN FOR: potential .fracture of left wrist . As a result of waiting to contact the physician, the physician did not order an x-ray until 5/22/17, 3 days after the fall. Additionally, the physician did not order a splint until 5/23/17, 4 days after the fall. During an interview on 6/20/17 at 1:30 pm, the Director of Nursing stated the facility should have called the physician the evening of 5/20/17 instead of using the physician communication log as the log delayed the communication to the physician. Review on 6/22/17 of the facility's protocol Contacting Family Practice Resident MD last dated 2/2013, revealed .Never compromise resident safety by causing a delay in care . |
2020-09-01 |