| 8203 |
FAITH HEALTHCARE CENTER |
425009 |
617 WEST MARION STREET |
FLORENCE |
SC |
29501 |
2012-08-22 |
328 |
E |
0 |
1 |
RTYQ11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews, observations, interviews, and review of facility policies and procedures, the facility failed to ensure that residents with tracheostomies had appropriate equipment and emergencies procedures in place in the event of decannulation for 2 of 2 residents observed with tracheostomies (#2 and #13). The findings included: Resident #2 arrived at the facility with a #10 cuffless [MEDICAL CONDITION]. He had had his [MEDICAL CONDITION] since 1998. The information about type and size of the [MEDICAL CONDITION] was documented on the hospital transfer forms at his admission in April 2012 and on his return from a hospital stay at the end of July 2012. The information was also included in the admitting nurse's note, and randomly throughout the nurses' notes by one particular nurse. It was not included in the physician's orders [REDACTED]. An observation of the resident's room at approximately 4:55 PM, in the company of a CNA revealed no evidence of a back-up [MEDICAL CONDITION]. At 5 PM, Licensed Practical Nurse (LPN) #3 was asked to show where the back up [MEDICAL CONDITION] was located. She stated that she had to call the Security Officer to unlock the storage room on the D wing. LPN #3 was asked if there was a back-up [MEDICAL CONDITION] in the resident's room, and she stated there was not. A search of the supply room revealed no back-up [MEDICAL CONDITION] for the resident. Only disposable inner cannulas in size 6 were noted. At 5:07 PM, LPN #3 returned to Unit C and in response to the question of what size tube was required, browsed through the resident's chart looking for the size and type of his [MEDICAL CONDITION]. LPN #3 paged the Unit Manager (UM) for Units AB and C. The RN UM responded to the page at 5:17 PM. Both she and LPN #3 searched the resident's room for the back-up [MEDICAL CONDITION]. At 5:30 PM, the RN UM was still looking. At 5:45 PM, the RN UM stated there was no back-up [MEDICAL CONDITION] for the resident. At 6:15 PM, LPN #3 was observed bringing the resident to the dining room. She stated they had taken him from the dining room to his room so they could check his [MEDICAL CONDITION] for size. It was size 10, just like he said. During the search of the resident's room, LPN #3 was asked if the resident pulled out his [MEDICAL CONDITION]. She replied that the nurses would sometimes find him at the sink in his room, brushing out his inner cannula. Review of the Nurse's Notes revealed two incidents in which the resident removed his inner cannula. A nurse's note on 7/20/12 at 5 PM stated the resident pulled out his inner cannula. A mucous plug was found and removed. The resident was provided with [MEDICAL CONDITION] care and suctioned. The pulse oximeter showed a reading of 96%. The next incident was noted in the 7/28/12 nurse's note at 10 PM. The resident had thick yellowish-green secretions and had been suctioned five times and provided with [MEDICAL CONDITION] care. . Pt (patient) has the tendency to be noncompliant (with) safety rules, with taking out the inner cannula of his trach. Pt pulled out his inner cannula on his own. Informed pt @ the beginning of the shift -> 7P, and throughout night, not to pull out his inner cannula & explained why. Review of the physician's orders [REDACTED]. The resident could also be suctioned as needed. The resident was hospitalized from 7/29 to 8/1/12 for pneumonia. Review of the resident's plan of care revealed three problems including the [MEDICAL CONDITION]. The resident had a potential for respiratory distress related [MEDICAL CONDITION] USE OF OXYGEN. Facility staff were directed to monitor for symptoms; do lung assessments as indicated; administer medications; check pulse oximeter readings as indicated; apply oxygen; and provide non-sterile [MEDICAL CONDITION] care. The resident had agitated behaviors, Resident will take out inner cannula of trach. Approaches to this problem included update physician; be supportive; be patient; explain why he should not exhibit these behaviors; inform family; and administer medications. The third problem stated Resident unable to speak related to [MEDICAL CONDITION]. Resident had a trach. Interventions for this problem included to ask the resident to speak slowly; ask him to repeat communications; remove him to a quiet location; be supportive; ask yes/no questions; ask other staff members to assist; have speech therapy work with him and communication book; and use pad and pen to write. The care plan did not state the resident's type and size of [MEDICAL CONDITION] or what to do in the event of decannulation. Resident #13 came to the facility with a stainless steel [MEDICAL CONDITION] in place. Review of the hospital discharge summary and the medical record failed to show documentation regarding the size of the resident's [MEDICAL CONDITION] or how long the resident had her [MEDICAL CONDITION]. No back-up cannula was noted in the resident's room on 5/20/12. Facility staff could not locate a back-up [MEDICAL CONDITION] for the resident. LPN #4 confirmed the resident had no back-up [MEDICAL CONDITION] at 7:15 PM on 5/20/12, and the company's MDS (Minimum Data Set) consultant confirmed at 7:30 PM on 8/20/12 that the size of the [MEDICAL CONDITION] was unknown. An interview with LPN #5 on 8/21/12 at 10:30 AM revealed the resident did remove her inner cannula, usually after [MEDICAL CONDITION] care. One time, the resident repeatedly removed the inner cannula when she was angry. Review of the medical record revealed the resident was found with her inner cannula in her hand on 6/24/12 at 6:30 PM. She initially refused to allow the nurse to reinsert it but after a few minutes and cleaning of the cannula, she did allow it to be reinserted. The inner cannula was found later that evening, according to the 7:10 PM nurse's note, lying on the bedside table. No respiratory distress was noted. The resident's [MEDICAL CONDITION] collar was adjusted and [MEDICAL CONDITION] care was provided. According to the 7:10 PM nurse's note, the resident pulled it out several more times. The next incident was recorded on 7/24/12 at 1:45 PM when the resident was noted to have removed her inner cannula and placed it on the bedside table. The resident had no complaints and allowed [MEDICAL CONDITION] care and reinsertion of the inner cannula. an order for [REDACTED]. Review of the plan of care for the resident revealed the information that she had a [MEDICAL CONDITION] was included in various problems, but there was no specific problem noting what size and type of [MEDICAL CONDITION] she used, the location of a back-up [MEDICAL CONDITION], or what to do in the event of decannulation. The resident had a potential for respiratory distress because of her [MEDICAL CONDITION] and history of airway obstruction related to stroke. Facility staff were to do lung assessments as indicated; monitor oxygen status; give support when experiencing shortness of breath or air hunger; administer medications and update physician; monitor for signs and symptoms of infection; perform vital signs as indicated; aerosol breathing treatments as indicated; change tubing and water bottle; administer oxygen; and use non-sterile technique for [MEDICAL CONDITION] care. The resident was unable to speak R/T (related to) Trach. [MEDICAL CONDITION]. Approaches included asking the resident to repeat; being supportive; asking yes/no questions; asking other staff to help; and allowing the resident to use gestures. The resident resisted care at times ([MEDICAL CONDITION] care, therapy, personal care) related to her desire to go smoke. Interventions included a calm and gentle approach; informing the resident of the next event prior to beginning care; reapproaching at a later time; updating the physician; and informing the resident of smoking times. As a result of the findings on 5/20/12 that 2 of 2 residents with tracheostomies had no back-up [MEDICAL CONDITION] cannulas available in the facility, the facility obtained [MEDICAL CONDITION] kits from the hospital that contained a range of cannula sizes. One kit was placed at each resident's bedside for emergency use. Since the size of resident #13's [MEDICAL CONDITION] was unknown, directions were given by the medical director to use a smaller size that would fit the stoma and send her immediately to the emergency room in the event of decannulation. During an interview with the DON and MDS Consultant, they stated that nursing staff had been through a skills check-off for care of residents with tracheostomies. The staff check-offs could not be located. As a result, the DON stated she would inservice the 7P to 7A staff on emergency decannulation procedures before leaving the facility on 8/20/12 and she would inservice the 7A to 7P staff on the morning of 8/21/12. Nursing staff not on duty would be required to have the training prior to taking care of residents with tracheostomies. Review of the facility's [MEDICAL CONDITION] Cannula Change policy presented to the survey team on 8/20/12 revealed under the heading Equipment: [MEDICAL CONDITION] cannula (size as ordered) and one size smaller needed to be available. Under the heading Procedure was 17. Maintain another [MEDICAL CONDITION] cannula (same size) on standby at resident's bedside. and 18. Maintain another [MEDICAL CONDITION] cannula one size smaller in the facility. |
2016-06-01 |