| 8228 |
MAGNOLIA MANOR - SPARTANBURG |
425091 |
375 SERPENTINE DRIVE |
SPARTANBURG |
SC |
29305 |
2012-04-18 |
314 |
E |
0 |
1 |
KT9K11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey based on observations, interviews and review of the facility's policy entitled Application of Dressing-Absorption Dressing on pressure ulcer care, the facility failed to assure that 2 of 2 sampled residents observed for wound care received treatment to promote healing and infection. The Unit #3 Manager did not properly wash her hands during wound care for Resident #10. For Resident #1 Licensed Practical Nurse #1 did not properly clean one wound, did not clean another wound, and failed to use proper hand washing technique. The findings included: The facility admitted Resident #10 on 12/12/11 with [DIAGNOSES REDACTED]. During wound care observation on 4/16/12 at 3:15pm, the Unit Manager completed wound care but failed to wash her hands prior to leaving the Resident's room. The Unit Manager used hand sanitizer before and after the wound care treatment. However, after completing wound care, the Unit Manager replaced items on the Resident's overbed table, raised the Resident's head of the bed, and repositioned the Resident to ensure the Resident was comfortable. The Unit Manager did not wash her hands before exiting the room. She then walked down the hall and placed treatment supplies in the treatment cart next to the nurse's station and then recorded the treatment in the Treatment Administration Record next to the sink. The Unit Manager then washed her hands at the sink behind the nurse's station. During an interview on 4/18/12 at 11:50am, the Unit Manager confirmed that she had left the Resident's room after completing the treatment, replaced supplies in the Treatment Cart, signed off the order in the Treatment Administration Record and then washed her hands. During an interview on 4/18/12 at 12:00 noon, the Staff Development Coordinator also confirmed that the Unit Manager did not wash her hands before leaving the Resident's room. and that the SDC had already told the Unit Manager she should have washed her hands prior to leaving the Residents room. Review of the facility's policy entitled Application of Dressing-Absorption Dressing provided by the Staff Development Coordinator on 4/17/12 at 12:00 noon stated hands are to be washed at intervals throughout the procedure. The facility admitted Resident #1 on 3/23/12 with [DIAGNOSES REDACTED]. On 4/17/12 at 10:55 AM, during observation of wound care for Resident #1, Licensed Practical Nurse (LPN) #1 washed her hands and entered the room. The surveyor and the Staff Development Coordinator were present for the treatment observation. LPN # 1 cleaned the bedside table, closed the door and moved the fall mat from the resident's bedside. LPN #1 explained the procedure to the resident, raised the bed and put on gloves. At that time, she assisted the resident to her right side. The LPN unfastened the resident's brief, removed the old dressing and placed it and her gloves in a biohazard bag. She washed her hands, applied saline to a 4X4 and twice patted the wound with the gauze using the same area of the gauze. She removed her gloves, removed a pair of scissors from her pocket, cleaned them, placed them on the barrier, and then washed her hands. While the LPN washed her hands the resident rolled back onto the brief. LPN #1 stated that the brief was clean and had just been changed prior to the wound care. The brief did not appear to be soiled. After washing her hands and putting on gloves, the LPN cut Calcium Alginate, placed it in the wound bed, covered it with gauze and applied tape. LPN #1 then stated that she was going to change the dressing on the second wound. The surveyor asked where the second wound was located as it had not been visible during the previously observed wound care and she was not aware of a second wound. The nurse stated it was on the resident's right ischial area and that she had removed the dressing earlier because it was soiled with urine. While the nurse washed her hands, the resident rolled partially to her back placing the exposed wound against the brief. The LPN returned, gloved and assisted the resident back onto her right side exposing the second wound. LPN #1 cut and placed Calcium Alginate into the second wound bed, covered with gauze and tape without cleansing the wound. The nurse removed her gloves, regloved and replaced the resident's brief with a new brief retrieved from the closet and repositioned the resident without washing her hands. LPN #1 then removed her gloves, cleaned the scissors with alcohol pads and placed them back into her pocket. She gathered used items and the biohazard bag. She took the biohazard bag to the housekeeping closet, placed it in a biohazard box and entered the soiled linen area, touching door knobs, and placed the used linens in a hamper. She returned to the nurse's station to wash her hands and sign the Treatment Record. On 4/18/12 at 9:20 AM, during an interview with LPN #1, she did not dispute the surveyors observations related to hand washing, gloving or touching items and the resident while gloved and using the same gloves during the treatment. The LPN did not disagree with the observation of patting the wound bed of the first wound with the same area of the gauze. When the LPN was informed that the surveyor had not observed her cleansing the second wound, the LPN stated that she had cleansed it when she cleansed the first wound. On 4/18/12 at 9:45 AM, during an interview with the Staff Development Coordinator (SDC), who was also present during the wound care for Resident #1, the surveyors observations were reviewed. The SDC agreed with the surveyor observations and stated that the nurse did not cleanse the ischial wound prior to placing the Calcium Alginate, gauge and tape. She also stated that the nurse patted the first wound instead of using a circular motion cleansing from the inside to the outside. Review of the facility's policy entitled Nursing Competency: Dressing-Absorption Dressing-Application of did not address the procedure to cleanse wounds. The SDC stated that they did not have any other wound care procedures. |
2016-06-01 |