cms_HI: 2

In collaboration with The Seattle Times, Big Local News is providing full-text nursing home deficiencies from Centers for Medicare & Medicaid Services (CMS). These files contain the full narrative details of each nursing home deficiency cited regulators. The files include deficiencies from Standard Surveys (routine inspections) and from Complaint Surveys. Complete data begins January 2011 (although some earlier inspections do show up). Individual states are provides as CSV files. A very large (4.5GB) national file is also provided as a zipped archive. New data will be updated on a monthly basis. For additional documentation, please see the README.

This data as json, copyable

rowid facility_name facility_id address city state zip inspection_date deficiency_tag scope_severity complaint standard eventid inspection_text filedate
2 HILO MEDICAL CENTER 125002 1190 WAIANUENUE AVENUE HILO HI 96720 2017-10-20 314 D 0 1 5D9Q11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interviews and Electronic Medical Record (EMR) reviews, the facility failed to ensure that 1 of 16 residents (R #31) on the Stage 2 Sample Resident List was provided care to promote healing, pain control and prevent infection due to an existing pressure ulcer (PU). Finding include: During an EMR review on 10/17/2017 at 08:31 AM R #31 was admitted with a Stage 4 pressure ulcer to the right buttock and hip. There were no orders for wound vac dressing changes three times per week (Monday, Wednesday and Friday). During an interview on 10/18/2017 at 11:04 AM, Staff #2 stated that staff nurses do the daily wound care which includes the wound vac dressing changes. The wound nurse does weekly assessments once per week. Queried where wound nurse documentation would be located and Staff #2 looked at EMR under Notes but there was no wound nurse documentation for the once a week evaluation. Staff #2 explained that if wound healing, wound nurse wouldn't document because wound healing nicely. Pointed out documentation by Staff #47 written on 10/05/17 at 11:27 in Nurse Note, wound Right butt: no overall improvement noted in R butt wound status. Per Staff #52, (Wound Nurse), obtain surgical consult for R butt wound. Documentation of the EMR revealed inconsistent information regarding the wound characteristics. The wound measurement flowsheet stated the wound had undermining which was at 2 cm; the wound length got larger. Staff #2 stated the inconsistency is probably due to different nurses measuring the wound. Staff #2 further stated that goals were the same, maintain granulation tissue and get closer to surface then outside start to shrink. There was no infection, no redness or warmth around and no slough. Staff #47 documented odiferous on 10/16 and wound nurses both noted wound not odiferous during dressing change. On 10/19/2017 at 9:22 AM observed Wound nurses Staff #52 and #53 do dressing change to R #31's R buttock pressure wound. Staff #53 obtained wound dressing supplies and placed them on the resident's overbed table without sanitizing or covering the overbed table with a clean barrier. Staff #53 had put on clean gloves and started removing the soiled dressing while Staff #52 assisted by placing the opened wound supplies onto the resident's bed, left in the wrapper. With the same gloves Staff #53 was observed to remove the dirty dressing, clean the wound, apply skin prep and the wound vac drape; then she proceeded to measure the wound depth with the same gloves. Discussed observations with both wound nurses and queried about practice of using same gloves between dirty dressing and clean dressing. Staff #52 stated that gloves are usually changed at least 5 times during a dressing change although that was not observed. Also, informed wound nurses that didn't observe them wash hands before putting on clean gloves. Both stated that they used hand sanitizing gel when they entered the resident's room. Informed them that observed them handling the wound vac machine and tubing with the clean gloves on before starting the wound care. Staff #52 stated that they will be sure to wash hands and change gloves between dirty and clean dressing change. During the dressing change R #31 was observed to jerk. Staff #37 stated that last pain med ([MEDICATION NAME] mg) was given at 6 PM. The extended release pain meds are given 12 hrs apart. During the Interview with R #31, the resident stated that he experienced shooting pains during the dressing changes and currently rated pain at 8 on a zero to 10 pain scale. When asked R #31 said that he did not tell the MD about his pain due to not being able to tolerate the [MEDICATION NAME]. Currently the Resident is being weaned off of the [MEDICATION NAME]. The facility did not follow standards of practice for wound care for the resident's Stage 4 pressure ulcer that promotes healing and prevents infection. 2020-09-01