cms_SD: 5095
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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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5095 | TIESZEN MEMORIAL HOME | 435069 | 312 EAST STATE ST | MARION | SD | 57043 | 2011-01-31 | 309 | G | XBEG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** A. Based on record review, nursing procedure review, professional standards, and interview, the provider failed to assess, monitor, and intervene in the individualized care and service to maintain the highest practical physical and psychosocial well being for one of one sampled resident (1) who had no recorded bowel movement (BM) for 13 days. Findings include: ?Review of resident 1's Medicare Assessment Form dated 12/15/10 through 1/19/11 revealed: ?Symbol key for use with documentation that included: -Check mark=assessment matched standard parameter. -H=deviation, chart findings (on this form or focus notes). -Arrow to left=deviation continues, no change since preceding H assessment. -P=pre-existing condition, describe. ?Standard parameters identified for "Gastrointestinal" that pertained to bowel elimination were: -Abdomen soft. -Nontender and nondistended. -Continent of bowels. -Passing [MEDICATION NAME]. -Bowel sounds present times 4 quadrants. -No N (nausea)/V (vomiting), diarrhea, constipation. -No tarry or bloody stools. -Stools brown, semi-soft, formed, describe if abnormal. -Supp (suppository)/enemas: type/color returned. ?12/15/10 at 9:15 p.m. There was a check mark and a note BS (bowel sounds positive X 4. There was also an asterisk with a note that read "res (resident) states BM was "last week." ?12/16/10 at 10:00 a.m. There was a check mark and an asterisk with a note that read "C/o (complains of) constipation Dr. ____ to see res. today will get order for bowels." ?12/16/10 at 8:20 p.m. There was a check mark and an asterisk with a note that read no BM. Those forms dated 12/17/10 at 9:25 a.m. through 1/19/11 at 1:30 p.m. had check marks indicating the assessment matched the standard parameters. There were no other notes on these dates related to bowel elimination. Review of resident 1's BM report roster dated 1/10/11 through 1/24/11 revealed no record of the resident having had a BM after 1/10/11 at 9:27 p.m. until 1/24/11 at 4:09 a.m. Review of resident 1's nurses' notes dated 12/15/10 through 1/24/11 revealed the following entries related to bowel elimination: ?12/16/10 at 2:30 p.m. Senakot 1-4 tabs (tablets) PO (orally) daily PRN (as needed, per request to nurse). Adjust per results. ?12//28/10 at 5:15 p.m. . . . frequently incontinent of bladder and continent of bowel. ?12/31/10 at 11:00 a.m. Weekly summary . . .Continent of bowels . . . . ?1/4/10 (incorrect year) at 2:20 p.m. . . . frequently incontinent of bowel/bladder. Wears pads at all Xs . . . . ?1/6/11 at 1:45 p.m. MDS (Minimum Data Set) 30 days Medicare assess . . . frequently incontinent of bowel/bladder . . . . ?1/21/11 at 5:30 p.m. Received the following order per T.O. (telephone order): [MEDICATION NAME] 17 gm (gram) daily. (May decrease dose if has loose stools). ?1/22/11 at 9:15 a.m. Orders from Dr. visit on 1/20/11 to increase Senna to 6 tabs PO daily, [MEDICATION NAME] 17 gm PO daily, [MEDICATION NAME] supp every 12 hours PRN. ?1/23/11 at 11:40 a.m. Dr. ____ faxed per pharmacy request to clarify Senna order. ?1/24/11 at 2:50 a.m. CNA (certified nurse assistant) reported res had a extra large loose BM and also appeared warm to touch and more lethargic than usual. T-103.3, P-124, R-24, B/P-88/44, SPO2-91% RA. LSC bilat. (bilateral). Also soft, NT with BS+ no pedal [MEDICAL CONDITION]. Tylenol given for increased temp. Fluids given. Review of resident 1's care plan revealed problem/need "Alteration in Bowel Elimination - Constipation" was 1/21/11; goal - resident will have BM every 2-3 days through 3/31/11. Approaches were [MEDICATION NAME] 17 gm daily, Senna 6 tablets daily, and [MEDICATION NAME] rectal suppository every 12 hours as needed. Review of the provider's prepared Patient Transfer Form to hospital dated 1/24/11 reflected resident had received Senna tablets and [MEDICATION NAME] for bowels with the last BM on 1/10/11. Review of 6/4/98 nursing procedure for Unusual complaints and symptoms revealed staff were to check vital signs and do assessment, chart in nurses notes, notify doctor if necessary, notify family if necessary, and put the chart on the UPPER RACK so each shift followed up. Interview on 1/31/11 at 12:00 noon with certified nurse assistant (CNA) A revealed CNAs used palm hand held or wall mounted electronic documentation devices. They were able and must record bowel elimination or BMs. The system prompted the individual to document the above. The CNA demonstrated by accessing a resident file and proceeded to the screen that read Bowel movement (BM) this shift? The CNA stated he/she was not able to print the report, but the nurses were able to access and print. The CNA believed the night nurse accessed the report and provided the information to the day nurse, so they would address. The CNA also indicated the nurse usually "does something," if there was no record of a BM after 3 days. CNA A preferred to carry the palm so "I can record things as they happen, but have to do it for sure before the end of my shift." CNA A also stated "Some of the older ones wait until the end of the shift." Interview on 1/31/11 at 12:20 p.m. with registered nurse (RN) B revealed he/she had worked on 1/20/11. Resident 1's physician discussed treatment options with him/her and his/her spouse and spoke to the resident's daughter per phone. RN 2 did not recall any discussion related to bowel elimination. Discussion was related to making decisions about hospice treatment or other interventions as RN 2 indicated resident 1 was not improving. Interview on 1/31/11 at 12:30 p.m. with RN C revealed nurses used the Medicare Assessment Form with no additional instructions other than what was on the form indicating the use of the symbol key. Interview on 1/31/11 at 12:40 p.m. with CNA D confirmed CNAs use the palm hand held or wall mounted electronic documentation devices to document bowel and bladder elimination plus "lots of other ADLs (activities of daily living)." CNA D reported the nurses were the ones who looked at how often the residents had BMs. If a resident did not have a BM after 2-3 days, the nurse usually gave a laxative or a suppository. Interview on 1/31/11 at 12:50 p.m. with RN E revealed there was no policy or procedure for the use of the Medicare Assessment form. RN E stated "It s pretty self explanatory." RN E reported a resident was given a laxative or a suppository when there was no BM after 3 days. RN E confirmed the CNAs documented BMs using the palm devices. He/she confirmed the night nurse pulled the BM reports and prepared a check list for the day nurse. The night nurse might give a suppository in the early a.m., but the night nurse provided the check list to the "cart" nurse every morning. Interview on 1/31/11 at 1:30 p.m. with the director of nurses (DON) confirmed there is no written policy or procedure for use of the Medicare Assessment Form, stating , "It is self explanatory, directions are on it." DON confirmed the CNA staff must document on bowel elimination each shift. The system prompted them and they could not leave without finishing that. DON continued confirming the night nurse checked the residents' BM reports, prepared a BM check list, and provided that list to the day nurse. When asked why there might have been no response or intervention after 2-3 days for resident who did not have a BM the DON stated, "The day nurse probably didn't share that information." The DON did not offer or provide anyone else or any other documentation when asked if there was anyone else or any other documentation he/she would like to have the surveyor review regarding resident 1. B. Based on record review, nursing procedure review, professional standards, and interview, the provider failed to prevent the development of a pressure ulcer for one of one sampled resident (1). Findings include: Provision of pressure ulcer care for resident 1 who acquired a pressure ulcer, accurate documentation of discovery and continued course of care documentation. Refer to F314. | 2014-04-01 |