| 3940 |
VALLEY VIEW SENIOR VILLAGE |
285294 |
220 SOUTH 26TH STREET |
ORD |
NE |
68862 |
2018-03-21 |
686 |
H |
1 |
1 |
OLWQ11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number 175 NAC 12-006.09D2b Based on observation, interview, and record review; the facility staff failed to implement interventions to promote the healing of pressure ulcers for 4 of 4 sampled residents including completing assessments, using clean technique for dressing changes, repositioning, and administering nutritional supplements as ordered. This affected Residents 3, 29, 24 and 34. The facility identified a census of 34 at the time of survey. Findings are: [NAME] Review of Resident 3's quarterly MDS (minimum data set-a comprehensive assessment tool used to develop a resident's care plan) dated 3/7/2018 revealed an admission date of [DATE]. Resident 3 had a Stage 4 (full thickness tissue loss with exposed bone, tendon or muscle) pressure ulcer that was not present at the time of admission. Review of Resident 3's admission MDS dated [DATE] revealed Resident 3 was admitted to the facility on [DATE] and had one Stage 2 pressure ulcer that was not present upon admission/entry or reentry. The date of the oldest Stage 2 pressure ulcer was 8/4/2016. Review of Resident 3's Physician Order Report for 2/6/2018-3/6/2018 revealed a [DEVICE] was being used to treat a sacral (tailbone) wound. Observation of Resident 3 on 3/14/18 at 7:31 AM, 9:28 AM, 1:36 PM, 3:17 PM and 4:20 PM revealed Resident 3 was sitting in the wheelchair. Interview with Resident 3 on 3/14/2018 at 3:17 PM revealed Resident 3 had been up in the chair since 7:30 AM and had not laid down in bed. Review of Resident 3's Resident Progress Notes for 3/14/2018 revealed no documentation Resident 3 had been offered the opportunity to change positions or educated about the risks of refusing to change positions. Observation of Resident 3 on 3/15/18 at 7:09 AM, 10:52 AM, 1:05 PM, 1:49 PM, and 3:20 PM revealed Resident 3 was sitting in the wheelchair. Review of Resident 3's Resident Progress Notes for 3/15/2018 revealed no documentation Resident 3 had been offered the opportunity to change positions or educated about the risks of refusing to change positions. Review of the undated NA (Nurse Aide) Pocket Guide revealed the following instructions for Resident 3: Lay down BID (twice) during the day. Interview with NA-U on 3/19/18 at 1:48 PM revealed the direct care staff carried pocket care plans with care instructions for the residents. Residents with pressure ulcers or who were at risk for skin breakdown were to be repositioned every 2 hours. Review of Resident 3's Medications Flow sheet for January, February, and (MONTH) (YEAR) revealed documentation that Resident 3 had wound area (pressure ulcer) pain and wound vac change pain ranging in intensity of 10/10 (worst pain you can imagine) 8 out of 10 and severe to very severe pain due to the pressure ulcer. Review of Resident 3's Wound Clinic note dated 2/16/18 revealed Resident 3's coccygeal (tailbone) ulcer went deep into the subcutaneous fat and the dressing changes were causing more discomfort. Review of Resident 3's Physician Order Sheet dated 3/7/2018 revealed the following: wound care nurse wrote a note to provider: routine wound vac changes are becoming extremely painful when wound is cleansed. Observation of RN-C (Registered Nurse) on 3/19/2018 at 11:22 AM doing dressing change for Resident 3's pressure ulcer to coccyx/sacrum (tailbone area) being treated with a [DEVICE] revealed the following: RN-C did 1 second hand scrub with hand sanitizer and applied gloves. The hand sanitizer did not cover all surfaces of RN-C's hands and RN-C's hands did not appear wet. RN-C then closed Resident 3's room curtains touching the rod with the gloved hands. RN-C then lowered the head of the bed touching the bed control with the same gloved hands. RN-C then picked the trash can up by the rim and moved it to where RN-C was working. RN-C then got more gloves out of the box in the bathroom and put them in the dressing bin. RN-C did not change gloves after touching the trash can before touching the gloves they put in with the other dressing supplies. RN-C then got supplies including [MEDICATION NAME] (pain medication) and dressings, touching them with the same gloved hands. RN-C then touched the bed control to raise the bed. RN-C then took the reservoir out of the [DEVICE] pump and removed the tubing. RN-C then removed the soiled dressings from Resident 3's pressure with the same gloves touching the wound. Resident 3 hollered out twice while RN-C was pulling the old dressing off. RN-C then rummaged around the bin of supplies with the soiled gloves and retrieved more supplies. RN-C then touched the wound edge and the dressing sponge that was in the wound with the same gloves. RN-C then discarded the sponge, put new gloves on, and squirted the [MEDICATION NAME] in the wound without performing hand hygiene. RN-C then put the new canister in the [DEVICE] pump that they had already touched with the dirty gloves. RN-C then opened the clean dressing package and touched the sponge. RN-C then took a pair of scissors out of their pocket and cut the sponge. RN-C did not clean the scissors or change gloves. RN-C then cut the transparent dressings with the scissors that were in their pocket. RN-C then washed the wound with soap and water on a washcloth and used a plain wet washcloth to rinse. RN-C then sprayed Resident 3's wound with wound cleanser and rinsed with saline, touching the canister of wound cleanser before placing it back in the bin with the remainder of the dressing supplies. The pressure ulcer to Resident 3' tailbone was deep. RN-C then changed gloves without performing hand hygiene. RN-C then got a dressing out of the tub that they had been rummaging in. RN-C then cut the sponge with the scissors they had taken out of their pocket and used without cleaning and placed it in the wound. RN-C then placed the cut transparent dressings around and over the wound and the sponge. RN-C then attached the hose to the canister after applying the adhesive dressings. RN-C then changed gloves without performing hand hygiene. RN-C then tore a hole in the dressing that was in the wound with a gloved finger. RN-C then turned the [DEVICE] pump on that was sitting on the floor. Resident 3 flinched twice after RN-C turned the [DEVICE] pump on and the suction started. RN-C then put the scissors in their pocket without cleaning them. Review of Resident 3's Wound Evaluation flow sheet dated 2/28/2018 revealed documentation that Resident 3's pressure had potential signs of infection including green slime exudate (drainage). Review of the facility policy hand hygiene revised 3/18 revealed the following: Purpose: to prevent the spread of infection through adherence of good hygiene practices. Policy: all personnel shall wash their hands with soap and water or use hand sanitizer to prevent the spread of infections. Wash hands with antimicrobial soap and water when hands are visibly soiled. Use an alcohol-base waterless antiseptic for routinely decontaminating hands when hands are not visibly soiled . When to practice hand hygiene: between resident contacts; after removing gloves; anytime hands are soiled; when going from a dirty to clean function on the same resident. Hand hygiene methods: antiseptic hand rub: apply adequate amount of alcohol-based waterless solution to palm of one hands. Rub hands together, covering all surfaces of hands and fingers, until hands are dry. Antiseptic hand wash: Moisten hands with water then apply enough soap to produce a lather. Rub hands vigorously for at least 10-15 seconds. Review of Resident 3's Wound Evaluation Flow Sheet received 3/14/2018 revealed no documentation Resident 3's pressure ulcer had been assessment since 3/5/2018. Interview with LPN-G (Licensed Practical Nurse) on 3/19/18 at 1:07 PM confirmed there was no documentation Resident 3's pressure ulcer had been assessed since 3/5/2018 (9 days). Review of Resident 3's progress notes for 3/5/2018-3/15/2018 revealed no documentation of an assessment of Resident 3's pressure ulcer. Interview with the DON (Director of Nursing) on 3/19/18 at 01:08 PM it was their expectation that wounds were assessed and documented on weekly. Review of Resident 3's Physician's Orders revealed the following: Peanut butter and jelly sandwich once a day at 3:00 PM with an order date of 10/26/2017, Ensure (dietary supplement) at each meal with an order date of 10/11/2017, and ProStat (protein supplement) 1 ounce twice a day mixed in diet soda with an order date of 3/16/2018. Review of Resident 3's Resident Supplement Chart for 2/17/18 to 3/18/18 revealed incomplete documentation of the supplement intake: PB & J (Peanut Butter and Jelly) sandwich only charted 3 days out of the month. Breakfast supplement (Ensure) was not charted on 2/17, 2/25, 3/9, 3/10, 3/11, and 3/15. Lunch supplement (Ensure) was not charted 2/17, 2/18, 2/24, 2/25, 3/4, 3/9, 3/10, 3/11, 3/15, 3/17, 3/18. Dinner supplement (Ensure) not charted on 2/19, 2/22, 2/24, 3/1, 3/2, 3/7, 3/10,3/11, 3/16, 3/17, and 3/18. Interview with the RD-O (Registered Dietitian) on 3/19/18 at 2:59 PM confirmed Resident 3 had a pressure ulcer that was not healing. RD-O confirmed the dietary supplements were not documented and should have been. RD-O revealed Resident 3 had been receiving Ensure TID (three times a day) and it was changed on 3/16/2018 to ProStat BID that is charted on the MAR (Medication Administration Record). Review of Resident 3's MAR for (MONTH) (YEAR) revealed the ProStat was started on 3/16/2018. The ProStat was documented as administered on 3/18 AM and 1700 (5 PM). It was not documented as administered any other time. B. Interview with Resident 29 on 3/13/18 at 3:22 PM revealed they were being treated for [REDACTED]. Resident 29 revealed they were supposed to go to the hospital last week and get the pressure ulcer surgically closed but it got infected so that got put on hold. Review of Resident 29's admission MDS dated [DATE] revealed an unhealed Stage 3 (full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed) pressure ulcer 2.0 cm long; 2.0 cm wide and 2.2 cm deep. Review of Resident 29's annual MDS dated [DATE] revealed an unhealed Stage 3 pressure ulcer that was 2.7 cm log, 2.2 cm wide and 3.2 cm deep which indicated the pressure ulcer had gotten larger. Interview with LPN-G on 3/19/18 at 1:34 PM revealed Resident 29 had a Stage 4 pressure ulcer that was marked a Stage 3 pressure ulcer on the annual MDS dated [DATE]. LPN-G confirmed the MDS should have reflected Resident 29 had a Stage 4 pressure ulcer. Review of Resident 29's Wound Evaluation Flow Sheet dated 8/29/17 revealed the pressure ulcer to the left ischium (hip/buttock) measured 1.4 cm x 1.4 cm x 1.8 cm. The pressure ulcer was a Stage 3 at that time. Review of Resident 29's Wound Evaluation Flow Sheet dated 12/5/2017 revealed the pressure ulcer to the left ischium measured 2 cm x 2 cm x 2 cm. Review of Resident 29's Wound Evaluation Flow Sheet dated 2/12/2018 revealed Resident 29 had a Stage 4 pressure ulcer to the left ischium (hip/buttock) that measured 2.7 cm (centimeters) by 2.2 cm and was 3.2 cm deep. The documentation on the Wound Evaluation Flow Sheet indicated the pressure ulcer had gotten larger and deeper. Observation of pressure ulcer care for Resident 29 on 3/13/2018 at 11:33 AM revealed the following: MA-B moved Resident 29's personal belongings from the over the bed table. RN-C then placed the supplies for the dressing change on the table which included scissors, dressings, and tubing. RN-C did not clean the table or apply a barrier before putting the dressing supplies on the table. RN-C donned gloves then turned off the [DEVICE] pump that was sitting on the floor. RN-C clamped the tubing from the [DEVICE] pump to the dressing on Resident 29's left hip then removed the soiled dressing. RN-C then removed the gloves, applied hand sanitizer and rubbed hands for 2 seconds then donned another pair of gloves. RN-C then washed the wound with a washcloth they had retrieved from the bathroom. The pressure ulcer was deep to the left hip. RN-C then opened the dressing package and cut the foam and clear adhesive dressings with the scissors that had been lying on the table. RN-C then laid the cut dressings onto the outside of the dressing package and the table. RN-C then placed one of the cut foam dressings into the pressure ulcer. RN-C then applied another piece of foam dressing that had been lying on the table onto the wound. RN-C then applied the clear adhesive dressings over the foam dressings then used the scissors that had been lying on the table to cut a hole into the clear adhesive dressings. RN-C then removed the gloves, washed hands for 3 seconds then applied another pair of gloves. RN-C then used a pre-moistened wipe to wash Resident 29's back side. RN-C applied a clean brief then assisted with repositioning Resident 29 to their back by touching the turn sheet then proceeded to wipe Resident 29's front side of the perineum (bottom). RN-C did not change gloves after cleaning Resident 29's back side before touching the clean brief, turning sheet, and cleaning Resident 29's front side. RN-C then removed the gloves, donned another pair of gloves then finished dressing Resident 29's bottom. RN-C then removed the gloves then touched the bed rail and gave Resident 29 the call light cord, which Resident 29 then proceeded to touch. RN-C then picked the scissors up off the table that they had used during the dressing change and put them in their pocket. RN-C did not wipe the table off or the scissors and did not perform hand hygiene after removing gloves. Review of Resident 29's Progress Notes for 12/15/2017 to 3/15/2018 revealed Resident 29 was treated for [REDACTED]. Review of Resident 29's Wound Culture Reports dated 2/27/18, 1/9/18, 12/27/17, and 12/22/17 revealed the pressure ulcer to Resident 29's left ischium showed infection. Interview with LPN-G on 3/15/18 at 11:14 AM confirmed that Resident 29's pressure ulcer to the left ischium was infected. Review of Resident 29's [DIAGNOSES REDACTED]. Review of Resident 29's Wound Evaluation Flow sheet revealed documentation the last assessment of Resident 3's pressure ulcer was 2/27/2018. The pressure ulcer was 1.8 cm long, 3.5 cm wide and 3 cm deep. Interview with LPN-G on 3/19/18 at 1:07 PM confirmed there was no documentation Resident 29's pressure ulcer had been assessed since 2/27/2018 (14 days). Review of Resident 29's Resident Progress Notes revealed no documentation of an assessment of Resident 29's pressure ulcer. Interview with the DON (Director of Nursing) on 3/19/18 at 01:08 PM it was their expectation that wounds were assessed and documented weekly. Review of Resident 29's Physician Order Report for 1/26/2018-2/26/2018 revealed an order for [REDACTED]. Review of Resident 29's Resident Supplement Chart documentation for 2/17/2018 to 3/18/2018 for cottage cheese per RD-O revealed there was incomplete documentation on 2/17, 3/6, 3/8, 3/11, 3/12, 3/13, and 3/15. Interview with the DON on 3/19/18 at 04:08 PM revealed that standard protocol was that hands were cleaned after gloves were used. After touching a dirty area with the hands or gloved hands staff were expected to clean hands and put on clean gloves. The DON confirmed the dressing changes were to be done as a clean procedure; by clean you would go from dirty to clean. Staff were expected to use a clean surface, wash the scissors, get their stuff together first and then put their gloves on and not touch everything. Review of the facility policy Pressure Ulcer Care revised 11/29/07 revealed the following: Residents having pressure ulcers receive necessary treatment and serves to promote healing, prevent infection, and prevent new pressure ulcers from developing. The resident's plan of care will be reviewed and revised at least quarterly and more often if a decline in function is apparent. Width and depth for Stage 3 and Stage 4 will be measured weekly. The physician will be notified of any pressure ulcers and a wound consult will be ordered. The physician will be notified weekly of the healing status of the pressure ulcer. Standard precautions will be utilized during wound care. C. Interview on 3-13-18 at 11:08 AM with Resident 24 revealed the resident had skin sores on the right calf and right heel and all had a dressing on them. Record review of the Pressure Ulcer Weekly Physician Notification form for Resident 24 revealed a unstageable (Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.) pressure ulcer to the right heel was identified 05/11/17. The initial measurement was documented as 1 cm (centimeter) x 0.8 cm x no depth. Review of the Wound Evaluation Flow Sheet dated 2-15-18 revealed the right heel pressure ulcer had increased in size and measured at 2 cm x 1.8 cm x 0.3 cm with dark eschar with severe pain documented. No further measurements were found of the pressure ulcer on the right heel. Observation of LPN-G on 3-15-18 at 1:30 PM revealed LPN-G performed the dressing changes to Resident 24's pressure ulcer wounds to the right calf and right heel. When LPN-G went to perform the dressing to the right heel, LPN-G revealed the Theraskin was not on the right heel and should have been. Interview on 3-19-18 at 10:01 AM with the LPN-G (Licensed Practical Nurse), who was also the wound nurse) revealed the resident had seen a Physician for the wounds on 2-22-18 and the initial Theraskin (a skin graft treatment to help heal wounds) had been applied to the pressure wounds. LPN-G revealed once the Theraskin had been applied, the dressing was only to be removed one time a week. On (MONTH) 1, LPN-G revealed LPN-G assessed the wound but did not document an assessment of the wounds. On (MONTH) 8 Resident 24 went to the Physician's office and LPN-G confirmed there were no papers received from the Physician's clinic to reveal the assessment of the wound. On (MONTH) 15, LPN-G performed the dressing changed and there was no assessment documented. The only documentation was in the PN (Progress Notes) which Area to R (right) heel appears to not have Thera Skin on. Clarification sent to Physician. Record review of Resident 24's current Careplan revealed the resident was to be in the recliner after breakfast and in bed after lunch for interventions to address the pressure ulcers. Record review of the Turn Schedule dated 3-15-18 to 3-16-18 which was hung on the resident's closet door revealed the resident was not turned for 3 hours from 0600 till 0900 on 3-15-18. Interview on 3-15-18 at 09:12 AM with NA-E (Nurse Aide) revealed the resident was extensive assist with cares. Resident 24 can tell the staff what the resident needs were. NA-E revealed the resident was turned every 2 hours during the night and after breakfast and lunch was laid down. Observation on 3-13-18 at 11:08 AM revealed the Resident sitting in the wheelchair. Observation on 3-14-18 at 09:30 AM revealed Resident 24 sitting in the wheelchair at an activity. Observation on 3-14-18 at 11:30 AM revealed Resident 24 sitting in the resident's room in the wheelchair. Observation on 3-14-18 at 1:37 PM revealed Resident 24 sitting in the resident's room in the wheelchair. Observation on 3-14-18 at 3:10 PM revealed Resident 24 sitting in the wheelchair in the resident's room. Observation on 3-14-18 at 4:07 PM revealed Resident 24 sitting in the wheelchair in the resident's room. Observation on 3-15-18 at 9:10 AM revealed Resident 24 was assisted out of bed by the staff for breakfast. Observation on 3-15-18 at 11:41 AM revealed Resident 24 was sitting in the wheelchair in the resident's room Observation on 3-19-18 at 11:17 AM revealed Resident 24 sitting in the wheelchair with the resident's head slumped forward asleep. Observation on 3-19-18 at 11:54 AM revealed Resident 24 sitting in the wheelchair. Observation on 3-19-18 at 2:30 PM revealed the resident was lying down in bed on the left side. However both of the residents legs, where the pressure ulcers were, were lying flat on the mattress and no offloading of pressure was to the wounds. Interview on 3-15-18 at 1:25 PM with Resident 24 revealed the resident lays down when the staff ask the resident but they had not been asking the resident. D. Review of Progress Notes in Matrix dated 2/22/18 upon admission revealed no measurements or staging of pressure ulcers. Review of Minimum Data Set (MDS-a federally mandated comprehensive assessment tool used for care planning purposes) dated 2/28/18 for Resident 34 revealed a BIMS (brief interview for mental status, test how you are functioning cognitively at the moment) score of 5, this indicated severe cognitive impairment. Review of undated [DIAGNOSES REDACTED]. that can cause urination difficulty), Suprapubic indwelling catheter (a surgically created connection between the urinary bladder and the skin around the umbilical region used to drain urine from the bladder), osteo[DIAGNOSES REDACTED] (bone infection), kidney disease, decubitus (pressure) ulcers (resulting from prolonged pressure on the skin), bursitis of the right hip (hip pain), [MEDICAL CONDITION] (decreased blood flow to extremities). Interview on 03/15/18 at 02:50 PM with Resident # 34 revealed, when asked, Do you lay down during the day? Resident 34 replied, Sometimes. They haven't been by to ask me to lay down yet. Interview on 03/15/18 at 03:08 PM with MA-D (Medication Aide-D) revealed staff assist the resident by helping put pants on. Resident 34 was able to do own shirt and other small tasks such as brushing teeth and combing hair. When asked about transfers MA-D stated, Resident can stand and walk pretty good. Doesn't usually lay down after meals and gets one bath a week per resident's request. MA -D confirmed resident has a sore on the the left heel and left hip. During an observation on 03/19/18 at 02:34 PM of dressing change to Resident 34's pressure ulcer on left heel and behind left ankle, RN-C did not remove soiled gloves prior to touching clean items in a plastic bag. Continued observation of the dressing change revealed RN-C placed the plastic bag of items on the floor with no barrier between the floor and the plastic bag. Bloody drainage ran onto items placed on a wash cloth on the floor for the dressing change. RN-C sat on the bare floor to complete the dressing change. RN-C did not change gloves from beginning of dressing change to the end. RN-C did not wash hand or use hand sanitizer. RN-C contaminated a pair of scissors taken from uniform pocket and replaced them into the same pocket without cleaning them. Observation on 03/19/18 at 02:34 PM during a complete dressing change on Resident 34 to left heel and back of left ankle by RN-C. RN-C washed hands. RN-C then pulled a trash can over to the side of Resident 34's wheelchair. Placed a white cloth on the floor by the wheelchair. Placed soapy clothes on the white cloth on the floor. RN-C placed a plastic bag which contained numerous items of dressings, bandages, tape, ointments, and Saline Spray on Resident 34's bed. Saline spray is used to moisten dressings to make them easier to remove when they become stuck. It is clean (sterile) since it is in a closed container. RN-C then put on gloves. RN-C sat down, on the floor, in front of Resident 34's wheelchair. The white cloth is on the floor just to her right. RN-C began to remove Resident 34's sock and shoe from the left foot. RN-C began to remove the old dressing, which was soaked with bloody drainage, from Resident 34's foot and back of ankle. RN-C then reached into the pocket of RN-C's uniform and removed a pair of scissors. The scissors were placed on the white cloth with the other clean items for the dressing change. The bloody dressing became stuck, closer to the skin. RN-C reached into the plastic bag which contained numerous supplies for dressing changes. RN-C dug into the bag several time and was unable to locate what item was needed. RN-C then slid the bag of supplies to the uncovered floor, not on the white cloth, and removed the can of Saline Spray. RN-C sprayed the soiled dressing, which began to run down and drip onto the scissors and other items on the white cloth on the floor. RN-C tried to remove the dressing and Resident 34 stated Ouch! That hurts! RN-C informed Resident 34 that the dressing was stuck. RN-C sprayed the dressing again and it came off. RN-C then took two (2) 4 X 4 gauze pads, touched the tube of [MEDICATION NAME] gel and squeezed the ointment onto the two (2) 4 X 4 gauze pads. RN-C did not change gloves, wash hands or use hand sanitizer. RN-C then placed the one (1) 4 X 4 gauze pad onto the wound on the back of the left ankle. RN-C then needed to apply skin prep (a protective coating that helps guard the skin against irritations) to the ulcer on the left heel. Resident 34 asked if it was going to burn. Resident 34 was hard of hearing and could not hear RN-C. Resident 34 replied, What did you say? RN-C stated, Hold on and applied the skin prep. Resident 34 stated, That hurts! RN-C then applied one (1) 4 X 4 gauze pad on the left heel, making no reply to Resident 34's comment about pain. RN-C reached into the plastic bag of supplies, took out a roll of Kerlix wrap and secured the 4 X 4 dressings into place. RN-C then used tape to hold the Kerlix wrap into place. The tape and [MEDICATION NAME] were placed back into the plastic bag. RN-C then placed the scissors back into uniform pocket. Resident 34 replied several time, My foot still hurts! RN-C informed Resident 34 that it was because the dressing was stuck. RN-C informed Resident 34 that the dressing and cleaning of the suprapubic catheter site would be done next. (Suprapubic catheter is a surgically created connection between the bladder and the skin used to drain urine from the bladder when a person has an obstruction (blockage) of normal urine flow). RN-C took off the gloves from the previous dressing change. No washing of hands or use of hand sanitizer was observed. RN-C gathered the supplies needed with ungloved hands. RN-C with ungloved hand moved trash can closer to the resident's wheelchair. RN-C then applied gloves, without washing them or using hand sanitizer. RN-C prepared the wash clothes to clean the catheter site. RN-C removed the old dressing and placed it into the trash can. New gloves were applied and the area around the site was cleaned. Area cleaned with soap and water, moving from inward at insertion site outward. Gloves were not changed, new dressing was applied and secured with tape. Tape placed back into plastic bag of supplies. Resident 34's clothing was adjusted and trash picked up from room. RN-C replied, I will wash my hands later. RN-C went into bath house and use hand sanitizer. Review of Treatments Flow Sheet dated 3/1/18-3/31/18 revealed dressing changes had been done 3/15/18, 3/18/18 and 3/19/18 with no measurements recorded on the, WOUND EVALUATION FLOW SHEET. Resident 34 had order for Profo Boot-offloading pressure on 3/6/18. Boots did not start getting applied until 3/16/18. Care Plan does not reveal what procedure was being done prior to Profo Boots. Review of Progress Notes dated 2/22/18 through 3/19/18 revealed no documentation since admission of resident refusing to be assisted to bed. Observation for five (5) hours from 09:15 AM until 01:50 PM revealed resident sitting in the wheelchair in various locations around the facility. Review of undated Care Plan revealed Resident 34 has no interventions that include changing positions and documenting refusals to lay down. |
2020-09-01 |