| 3 |
SEA VIEW NURSING HOME |
485000 |
7500 BOLONGO BAY |
ST THOMAS |
VI |
802 |
2010-08-25 |
309 |
G |
0 |
1 |
MZE911 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, review of resident medical records and facility policy and procedures, it was determined that the facility failed to ensure that each resident received the necessary care and services to manage pain. The facility does not have a formal system in place for pain management. This was evident for 2 of 10 residents who were observed to not receive medication for pain prior to , during , or immediately following wound care. The Findings are: 1. Resident #1 is a [AGE] year old female with [DIAGNOSES REDACTED]. The resident had a fall on 7/11/10 which resulted in a right [MEDICAL CONDITION] and a Total Hip Replacement (Hemiarthroplasty). The resident has a history [MEDICAL CONDITION] the soles of her feet. Although [MEDICAL CONDITION] healed, the resident's nursing documentation indicates the resident continues to experience tenderness at the burn sites. On 08/23/2010 @ approximately 2:20 p.m., a dressing change of the residents right heel was observed. The nurse performing the dressing change, was observed to check the doctor's order, sanitize her hands and then gathered supplies. As the old dressing was being removed, the resident groaned audibly. She was heard to groan twice. The Nurse (RN) performing the dressing change, did not pause or stop the procedure. She did, however, acknowledge the resident's painful response by saying to her I am sorry honey and continued with the wound care. She did not stop to assess the severity of the resident's pain and she did not offer the resident pain medication. When the surveyor asked the RN if the resident had received pain medication prior to the dressing change she replied, I am not entirely sure she if she has pain medication ordered. An interview was conducted immediately following the dressing change with this nurse. The nurse was asked why she did not stop, assess or offer the resident pain medication when the resident clearly was experiencing pain. She replied, She only does that when you are messing with her foot. The nurse was asked under what conditions would she give the resident pain medication. She answered, I would give it, if she asked for it. Review of the Physician orders [REDACTED]. 1. Tylenol 650 mg Q4HR PRN for pain or Temp 100 PO, 2. [MEDICATION NAME] 5/500 mg Q4HR PRN PO. The facility's Policy and Procedure for Treatment and Dressing Changes includes instructions to : Ask if the resident would like pain medication prior to treatment Review of a Wound Care Protocol revealed that the procedural Instructions only address Stage III Decubitus. The last sentence in those instructions for a Stage III Decubitus reads: Medicate for pain relief if indicated prior to treatment 2. An LPN was Observed to prepare for and perform a Stage 3 Sacral wound treatment on 8/24/10 at 3:40 P.M. A CNA ( Certified Nursing Assistant) was in attendance at the resident's bedside. In preparation, the nurse removed a roll of tape from the treatment cart, cut several strips of tape from the roll and stuck the cut strips to the residents bedside table. The nurse was then observed to take a blue Chux pad, handed to her by the CNA assisting with the treatment, removed a used pair of scissors from the wound treatment cart and used this scissor to cut the Chux in half. One half of the Chux was placed onto the resident's bedside table. The nurse then proceeded to the resident's bathroom to wash her hands. After donning gloves, the nurse removed a bottle of Normal Saline from the top of the treatment cart, opened the cap of the Normal Saline bottle, and placed the bottle onto the Chux draped bedside table. Several sterile guaze pads (4x4's) were placed onto the Chux . The nurse poured Normal Saline onto the guaze, removed a box of gloves from the treatment cart, and placed the box onto the Chux draped table. A clear plastic bag, taken from the treatment cart , was taped onto the resident's bedrail. The nurse was observed to then remove her gloves and proceed to the bathroom to wash her hands. After returning to the resident's bedside, the assisting CNA and the nurse re- positioned the resident, and the nurse removed the resident's Attends brief. Fecal matter was observed on the Attends brief. The soiled Attends brief was placed into the plastic bag hanging on the residents bedrail. Old dressings, saturated with purulent drainage, were removed from the wound site and discarded into the clear plastic bag taped to the resident's bed. The nurse stopped the treatment , cleansed the resident's buttocks and entered the residents's bathroom where she was observed to wash her hands for 8 seconds. Upon returning to the resident, the nurse put on a new pair of gloves, poured Normal Saline onto the Chux draping the bedside table, picked up a previously Normal Saline soaked guaze and began to use to the guaze ( in a patting motion) to soak up the Normal Saline just poured onto the Chux. The nurse proceeded to use this guaze to cleanse the sacral wound. This procedure was repeated six times. Following this cleansing method, the nurse was observed to pick up a previously soaked Normal Saline guaze, dip it into the pool of Normal Saline previously poured onto the Chux pad and to use this guaze to pack the wound site. She was observed to cover the site with a dry guaze taken from the Chux pad. After applying tape to the site, the nurse removed her gloves and then entered the resident' bathroom to wash her hands. She was observed to wash hands for 6 seconds. The CNA, who was not wearing gloves, disposed of the clear plastic bag which contained the old dressings, and soiled Attends brief. During these dressing changes, the resident was observed to frequently blink her eyes rapidly, particularly during the sacral wound treatment, and to become very diaphoretic. When the nurse was asked if she thought the resident was experiencing pain, The nurse replied, no, I don't think she's in pain. When asked if the resident had been medicated for pain prior to wound care, the nurse responded, no, I do her dressings all the time and I never had to medicate her before. A review of the resident's medical record conducted after the wound care observation revealed Nursing and Social Worker documentation indicating that the resident elicits response to painful stimuli. A Nursing Note dated 6/7/10, reads She does not respond to verbal commands, but she does respond to painful stimuli by making sounds. Social Services documents on a Social Services Quarterly Summary 12/16/09, Patient is non-verbal and not responsive though there are facial expressions that indicates pain and discomfort. Upon review, Physician order [REDACTED]. The Medication Administration Record [REDACTED]. When this concern was communicated to the Director of Nursing Services on 8/2410, an order for [REDACTED].> |
2017-01-01 |