cms_TN: 10116
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10116 | NHC HEALTHCARE, DICKSON | 445004 | 812 CHARLOTTE ST | DICKSON | TN | 37055 | 2012-02-15 | 280 | E | 0 | 1 | KPFB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, observation and interview, it was determined the facility failed to revise the comprehensive care plan to reflect the current status for elevating legs, [MEDICAL CONDITION]-embolic device (TED) hose, bleeding precautions, bed alarm, ortho boot, orastretcher, hand splint, a roll guard, feeding a resident at each meal and/or not to obtain weights for 6 of 27 (Residents #1, 5, 6, 10, 13 and 14) sampled residents. The findings included: 1. Review of the facility's care plan development policy documented, .9. Problems: a. Problems are patient conditions, needs, or weaknesses which currently do, or potentially could, prevent the patient from achieving or maintaining the highest practicable level of well being . 2. Medical record review for Resident #1 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED].Keep legs elevated when possible . Review of a physician's orders [REDACTED].Measure for TED hose, below knee, on Q (every) AM, off at HS (hour of sleep) . The care plan dated 1/12/12 was not updated to reflect interventions for elevating legs and TED hose. During an interview in the education room on 2/15/12 at 10:30 AM, Nurse #4 was asked if the interventions for elevating legs and TED hose were on the care plan. Nurse #4 stated, Its's (interventions for elevating legs and TED hose) not on there (care plan) because I haven't updated the care plan . 3. Review of the Nursing 2012 Drug Handbook, Lippincott Williams & (and) Wilkins documented, .[MEDICATION NAME] Sodium [MEDICATION NAME] Nursing Considerations: Regularly inspect patient for bleeding gums, bruises on arms or legs, petechiae, nosebleeds, melena, tarry stools, hematuria and hematemesis . Medical record review for Resident #5 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a physician's orders [REDACTED].[MEDICATION NAME] 60 mg (milligram) sq (subcutaneous) q (every) day x (times) 6 w (weeks) . The care plan updated 1/31/11 was not revised to reflect care for bleeding precautions for the use of an anticoagulant medication [MEDICATION NAME]. During an interview in the education room on 2/15/12 at 8:55 AM, Nurse #5 reviewed Resident #5's medical record and stated, .There is nothing on the care plan related to bleeding precautions and [MEDICATION NAME] . 4. Medical record review for Resident #6 revealed an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the POS [REDACTED].INTERVENTIONS: BED ALARM PLACED UNDER PATIENT . The care plan initiated on 1/9/12 to the present had not been revised to reflect the intervention of a bed alarm. Observations in Resident #6's room on 2/14/12 at 8:10 AM and at 3:00 PM, revealed a bed alarm on Resident #6's bed. During an interview in the unit 1 nurses' station on 2/14/12 at 3:30 PM, the Assistant Director of Nursing (ADON) confirmed the bed alarm should be on the care plan. 5. Medical record review for Resident #10 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of an order dated 9/28/09 documented, .Remove ortho Boot daily during Bath and to assess skin integrity . Review of an order dated 8/1/11 documented, .Orastretch to be performed 5x (times)/ (per) week by restorative/nursing @ (at) 7 second hold @ 20- (to) 25 . Review of an order dated 8/3/11 documented, .provide training to caregivers, family & (and) restorative nursing/nursing staff on orastretcher device and how to use . Review of the physician's recertification orders dated 2/29/11 documented, .(R) (right) HAND SPLINT: ON AT 1ST (first) ROUND, OFF AT 2ND (second), ON AT 3RD (third), OFF AT 4TH (fourth), ON AT 5TH (fifth), OFF AT 6TH (sixth) . Review of the November 2011, December 2011 and January 2012 treatment records documented, .Stretch mouth using oral stretcher @ 20-25 level for 7 seconds daily . Remove ortho boots daily (during bath) & check for skin irritation. Review of the care plan dated 1/6/12 was not revised to reflect interventions for ortho boot, orastretcher and right hand splint. During an interview in the education room on 2/15/12 at 10:40 AM, Nurse #4 was asked if the ortho boot, right hand splint and the orastretcher were on the care plan. Nurse #4 stated, .No, I don't see it . 6. Medical record review for Resident #13 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of a post falls assessment completed on 8/5/12 documented the resident was found on the floor beside the bed with the intervention to prevent further falls was to have roll guards placed on the bed. Review of the care plan dated 1/2/12 documented, .Falls, at risk for as evidenced by Dementia w/ (with) poor safety awareness; inability to self transfer, Severe [MEDICAL CONDITION] with risk of fractures PMH (past medical history); UE (upper extremity) & (and) LE (lower extremity) fractures . The care plan was not revised to reflect the intervention for roll guards on the bed. During an interview on in the education room on 2/15/12 at 8:00 AM, the Assistant Director of Nursing (ADON) was asked about the roll guards on the care plan. The ADON stated, That one (roll guard intervention) is not on there. Review of a nurses note dated 2/4/12 documented Resident #13 spilled coffee in her lap during a breakfast meal with the intervention to prevent any further spills to always feed the resident. Review of the care plan dated 1/2/12 was not revised to reflect that Resident #13 is to be fed at each meal. During an interview in the education room on 2/15/12 at 9:45 AM, the ADON was asked about the intervention to feed the resident at each meal documented in the nurses notes dated 2/14/12. The ADON stated, It (intervention to be fed at each meal) hasn't been added on here (care plan). 7. Medical record review for Resident #14 documented an admission date of [DATE] with [DIAGNOSES REDACTED]. Review of the physician's orders [REDACTED]. The care plan dated 12/16/11 documented, .Weigh: weekly X (times) 4 and then monthly . The care plan was not revised to reflect the intervention not to weigh Resident #14. During an interview in the Minimum Data Set Coordinator's office on 2/16/12 at 3:15 PM, Nurse #7 was asked if weights should be on the care plan after the physician had ordered no weights. Nurse #7 stated, .weighing should have been taken off of the care plan . | 2016-07-01 |