cms_PR: 11
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 11 | RYDER MEMORIAL HOSPITAL INC | 405018 | 355 AVE FONT MARTELO | HUMACAO | PR | 792 | 2017-05-04 | 314 | G | 0 | 1 | ZOYB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on a recertification extended survey, observations from 5/2/17 thru 5/4/17, interviews with nursing staff and record review (RR), it was determined that the facility failed to establish preventive measures to avoid the development of pressure ulcer for 1 out of 8 residents in the sample selection (R# 2) . Findings include: 1. Resident #2 is an [AGE] years old male who was admitted on [DATE] with a [DIAGNOSES REDACTED]. The resident was admitted to the SNF for antibiotic therapy and rehabilitation. He is bedridden since (MONTH) (YEAR) due to the Pneumonia. 2. During RR performed on 5/2/17 from 1:30 p.m. thru 3:45 p.m. the following was found: a. The Protocol of prevention and Management of patients with alteration in skin integrity. Protocolo de Prevencion y Manejo de Pacientes con alteracion en integridad de piel that the Registered Nurse (RN) in charge of performing the admission of the resident on 4/29/17 identified on the section called as Estimado de Factores de Riesgo Estimating risk factors that the resident has Musculoskeletal limitations. On the Braden scale (risk for developing ulcers) the points obtained was 15, meaning that the patient is not at high risk of developing ulcers. b. The ulcer protocol was found in the record. The criteria that were indicated are: Make assessment of the skin and observe changes, evaluate: State (turgor, appearance), Location of pressure area, Pressure Area Size, Appearance (red, wet, dry), and Type of exudate (color and quantity). However, the only thing that was marked was to estimate the skin and observe changes, not specifying which skin issues the nurse is going to evaluate. The other interventions identified by the RN were to evaluate: Keep resident bed dry, clean and wrinkle free, Make use of pillows to position and provide comfort, Lifting heels out of bed with pillows or splints, Use of protectors in elbows and heels, Care for the back and osseous prominences by applying lubricating lotions, Minimize trauma to remove tape or tape in skin, Care according to medical order. c. The initial evaluation performed by nursing staff the section of the integumentary system subsection 1. Condition of the skin only marks dry skin. d. The initial medical evaluation indicates that the patient only has rash in the sacral area. e. The sheets of the Protocol of Prevention and handling of residents with alteration in the integrity of the skin of days 4/30/17, 5/1/17 and 5/2/17 indicate that multiple lacerations are observed and [MEDICATION NAME] is being applied and [MEDICATION NAME]. It is observed that [MEDICATION NAME] was only being applied once a day and not twice a day according to the medical order of 4/29/17. It was also found that in the medical order of 4/29/17 the doctor writes that the [MEDICATION NAME] Cream should be applied in the area of the sacrum and pubic areas at each diaper change. f. No documentation of the RN was found on the clinical record indicating what interventions she performed to decrease the red skin on the buttocks area. It was not determined the frequency in which the skin medications were administered. g. The progress notes of the registered nurses do not reflect the observations and care provided by the RN who is the professional that is performing the Braden Scale assessment, daily skin assessments, and the care provided to the [MEDICAL CONDITION]. h. No evidence was found on the registered nurses progress notes information related to the importance of doing changes position every 2 hours to avoid skin breakdown. This is part of skin prevention aspects that is recommended on the guidelines for Prevention and treatment of [REDACTED]. 3. On 5/3/17 at 11:00 am when the resident was visited, the sister told the surveyor that she is worried because her brother has a rash in his buttock and in the sacrum; when the nurse came to change the diaper she saw blood on the brief. Surveyor asked about what the nurse is applying on the rash and she said and ointment cream. The surveyor asks her how she found this. She stated that her brother told her that it hurts quite in the back. When she checked the resident's sacrum area it was redder than yesterday and with some blood. 4. The resident can perform by himself the changes of position. However, during the survey process, it was observed that the resident remained in the same position when observations were performed on different days and hours. 5. On 5/3/17 at 9:05 am the license practical nurse (LPN) in charge of the resident was asked by the surveyor about what is happening with resident #2. She indicates that she is applying an ointment that the resident has in the drawer and when she bath the resident she applied it on the laceration areas. She stated: The RN is in charge to apply the medication on the resident lacerations. The surveyor asked if she wants to access the resident skin and she said that the LPN do the assessment during the patient bed bath. The RN observed the area and indicates that the area is red and with some blood spots because of the friction of the brief due to the resident movements. She says that the skin it is not open. 6. On 5/3/17 at 11:20 am the surveyor accompanied by the infection control preventionist (employee #7) requested for a RN to look at the affected area of the resident. The RN indicated that she was going to care the lacerations in that moment. Employee #7 asked to the RN what she is applying to the resident; the RN answered that she has to check because she did not remember. 7. However, no documentation related to this new problem was found on the clinical record. The nursing staff failed to identify the new concern, to write their observations on the daily skin assessment form and to develop a plan of care according to the new findings observed. 8. The facility failed to ensure an accurate initial assessment to implement a protocol for risk of pressure ulcer development. | 2020-09-01 |