| 11289 |
BRAXTON HEALTH CARE CENTER |
515180 |
859 DAYS DRIVE |
SUTTON |
WV |
26601 |
2009-02-10 |
309 |
D |
1 |
0 |
33YV11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interviews, the facility did not ensure one (1) of three (3) sampled residents received timely care and services to maintain physical well-being. Resident #59 sustained a [MEDICAL CONDITION] humerus and was not seen by an orthopedic specialist until eight (8) days later. Additionally, Resident #59 did not receive a skin assessment or skin care under an Ace wrap that was ordered by the physician to immobilize the fractured humerus, resulting in the development of an open area. Facility census: 58. Findings include: a) Resident #59 1. An interview with the director of social services, on 02/10/09 at 12:20 p.m., revealed she did not make medical appointments for the residents. She stated the admission coordinator was responsible for making these appointments. An interview with the admission coordinator, on 02/10/09 at 12:45 p.m., revealed she received a physician's telephone order from the nursing department requesting an appointment for Resident #59 to see an orthopedic specialist. The physician's orders [REDACTED]. She stated she told the specialist's office staff the resident had a fracture to her right elbow and needed to be seen as soon as possible. A nursing note, dated 10/29/08 at 3:50 p.m., revealed, "Resident transferred from bed to wheelchair using total body lift with assist of 2 CNA's (certified nursing assistants) and this nurse. Resident transferred without difficulty. Some crying noted, but stopped crying when sitting in wheelchair. Bruise to right inner elbow with [MEDICAL CONDITION] noted. Sitting upright with good posture." Another nursing note at 4:00 p.m. revealed, "Spoke with daughter about the bruising and swelling of elbow. Explained we are going to obtain a x-ray and will let her know of the results." A nursing note at 5:15 p.m. indicated, "Imaging contacted this nurse by phone and reported right distal humerus non-displaced fracture to right elbow. MPOA stated I think it could of happened when being dressed, because she is stiff." Nursing notes continued from 10/29/08 to 11/03/08, describing the condition of the resident's right elbow area. An order was received from the physician on 10/30/08, to apply an immobilizer Ace wrap to the right arm and to leave in place until the orthopedic appointment. There was no evidence of attempts by any staff to call to schedule an appointment with the orthopedist until 11/03/08, when a telephone order was received from the physician to order an appointment with an orthopedic specialist. An interview with the director of nursing (DON), on 02/10/09 at 1:00 p.m., revealed it was very difficult to get an appointment with an orthopedic specialist in the area. She stated the nursing staff had attempted to get an appointment and was not able to do so. (There was no documented evidence of these efforts by the nursing staff to obtain an appointment for the resident.) The resident was diagnosed with [REDACTED]. 2. A review of the resident's medical record revealed [REDACTED]. At 5:15 p.m., a report from the x-ray department indicated the resident had a [MEDICAL CONDITION] distal humerus that was non-displaced. At 7:35 p.m., a nursing note described the resident as exhibiting signs of discomfort related to the right arm. A physician's orders [REDACTED]." An interview with the DON, on 02/10/09 at 11:00 a.m., revealed the Ace wrap was placed on the resident in accordance with the physician's orders [REDACTED]. The resident returned to the facility without the wrap, which was removed at the physician's office. She further stated they did not remove the Ace bandage during this time, frame because the order from the physician clearly indicated the Ace wrap was not to be removed. The staff washed the resident around the Ace wrap but not under the wrap. When the resident returned to the facility from the physician's office she was assessed with [REDACTED]. The resident's hand remained in this position, resting against her breast for seven (7) days. On 11/06/08 at 4:40 p.m., the resident returned from the appointment with the orthopedic specialist without the Ace wrap. The specialist's report indicated the resident was not to have the Ace wrap applied and that the area would heal without problems. Surgery would not be necessary and to not passively extend the right elbow. A sling may be used for comfort. A nursing note, dated 11/06/08 at 7:20 p.m., indicated, "This nurse entered room for assessment. MPOA (medical power of attorney) was upset with red areas to left breast and right hand. Measurement right thumb 1.5 cm length and 2 cm width. Right hand 2nd knuckle 1 cm x 2 cm outer wrist bone on right arm 1 cm x 1 cm left breast top red area 5 cm x ? cm area below. Skin is not open." At 9:30 p.m., a nursing note indicated, "Red areas fading in color." An interview with the DON, on 02/10/09 at 1:00 p.m., confirmed the resident had an open area on the left breast. She continued to state they could not remove the Ace wrap, because they had an order not to remove. She further stated the resident could be very combative, and to attempt to remove the Ace wrap may have caused problems with the resident right elbow fracture. The facility failed to ensure the resident's skin was assessed and cleaned under the Ace wrap for seven (7) days. . |
2014-07-01 |