| 10262 |
MAGNOLIA PLACE - GREENVILLE |
425361 |
35 SOUTHPOINT DRIVE |
GREENVILLE |
SC |
29607 |
2010-10-18 |
280 |
D |
|
|
DFY111 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the complaint survey, based on record review and interview, the facility failed to revise and update the Care Plan for 1 of 4 sampled residents reviewed for Comprehensive Care Plans. Resident #1's Care Plan had not been updated regarding approaches used for proper positioning and to prevent and/or care for Pressure Ulcers. The findings included: The facility admitted Resident #1 on 09/06/2002 and readmitted her on 12/10/2004 with [DIAGNOSES REDACTED]. Observation on 10/18/2010 at 12:35 PM revealed the resident lying on a specialty mattress with the head of bed elevated. Review of the cumulative Physician order [REDACTED]. Review of the Physician/Nurse Practitioner Progress Notes on 10/18/2010 at 1:15 PM revealed the following: 06/16/2010- "S(ubjective): Resident had an area of skin compromise noted to her sacrum. Initial treatment was the use of [MEDICATION NAME] although wound treatment nurse reports the skin was intact at that time. However, we were called to see the resident today due to changes in the sacral wound...P(lan): ...Also, initiate a specialty mattress surface for the resident to minimize skin breakdown and to offload this area". 07/12/2010- "Patient is an elderly white female with a known history of advanced dementia, ... and essentially total care for activities of daily living (ADLs) and instrumental activities of daily living (IADLs)...". 07/14/2010- "Chief Complaint: Pressure Area. S(ubjective): Resident is frail and debilitated, cachectic, with wound on her sacrum...O(bjective): The wound is open...Heels are intact... P(lan): ...Keep resident turned and positioned...". 07/28/2010- "P(lan): She is on double shot protein q.i.d. (4 Times daily)...Heels are intact...Encourage turning and repositioning". 08/09/2010- "P(lan): ...Keep resident turned and repositioned". 08/30/2010- "P(lan):...Encourage turning and repositioning, although due to her frailty and debility would contribute greatly to poor wound healing. She is also very thin...". 09/29/2010- "Chief complaint: Pressure areas. S(ubjective): Resident was seen by this provider for follow up of a pressure area on her sacrum. She has developed other areas of skin compromise. O(bjective): ... On the left outer heel is a smaller wound that measures approximately .1 cm (centimeters) The wound is dark brown, purple coloration, with peeling edges. No open areas at this time...P(lan): Encourage turning and repositioning....She is already on double shot protein...". Review of the Care Plan for Resident #1 on 10/18/2010 at approximately 1:40 PM revealed page 13 of the Care Plan folded over. Written on the fold was "7/7/10 New Skin Integrity Care Plan Printed". On the folded page were approaches listed for the problem of being at risk for impaired skin integrity with the "Date(s)" listed as 10/13/2009, 01/04/2010, and 04/06/2010. The "Goal" was that "Resident's skin will be free from irritation and breakdown" with an evaluation date of 07/06/2010. The approaches listed included "Turn and reposition every 2 HRS (hours), Assess nutritional status, Keep skin dry and clean, Assess skin condition PER POLICY, float heels as ordered, ...". Further review of the Care Plan for Resident #1 revealed there was an entry dated 07/14/2010 that addressed the problem of being at risk for impaired skin integrity related to skin tears, but it did not include approaches to prevent or care for pressure ulcers. Continued review revealed "Problem Start Date: 07/07/10, Resident has a pressure ulcer Stage III to sacrum". The goal was listed as "Resident's ulcer will decrease in size and ulcer will not exhibit signs of infection...". The approaches listed included the following: "Use pads or briefs to maintain personal hygiene and dignity, Keep clean and dry as possible. Minimize skin exposure to moisture, Keep linens clean, dry, and wrinkle free. Conduct a skin inspection weekly, and daily per policy. Report any signs of any further skin breakdown. Assess pressure ulcer for location, stage, size (length, width, and depth), presence/absence of granulation tissue and epithelization, and condition of surrounding skin. Follow wound care nurse and provider's recommendations and orders related to dressing changes. Provide incontinence care after each incontinent episode." There was no mention of the Nurse Practitioner's recommendation to keep the resident turned and repositioned, that the resident used a specialty mattress, that Resident #1's heels were to be floated, or that the resident should be in her geri-chair with foam cushion for proper positioning while out of bed. During an interview on 10/18/2010 at 1:48 PM, one of the Minimum Data Set (MDS) Coordinators (Registered Nurse #1) reviewed the Care Plan and verified that the folded page was not included in the current Care Plan. She verified that there was not a "7/7/10 New Skin Integrity Care Plan" and that the current Care Plan did not address turning and repositioning the resident or floating the resident's heels. She stated that another MDS Coordinator had been responsible for updating Resident #1's Care Plan and that this nurse had just started in July. She stated she would look to see if there were any more pages that should have been included in Resident #1's Care Plan. Upon return, she did have some pages to add, but none related to skin breakdown or pressure ulcer care. |
2014-02-01 |