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METHODIST HOSPITALS OF MEMPHIS
NURSING CARE PLAN
Tag No.: A0396
Based on record review and interview, the hospital failed to ensure the nursing care plan (POC) was implemented for 1 of 4 (Patient #4) sampled patients.
The findings included:
1. The hospital "NO ULCERS BUNDLE and Skin Care Policy" policy revealed, "...PURPOSE: Identify level of risk, assess skin integrity, develop and implement plan of care to maintain and/or improve skin status...Use moisture barrier products for each incontinence episode and as needed..."
2. Medical record review revealed Patient #4 was admitted to the Intensive Care Unit (ICU) on 5/9/19 with diagnoses which included Klebsiella Sepsis, Anemia, Thrombocytopenia, Diabetes, Acute Systolic Congestive Heart Failure, Acute Dyspnea, and Ureterolithiasis.
The Initial Skin Assessment dated 5/9/19 at 11:30 AM, revealed Patient #4's skin was intact.
The (POC) included the use of a purwick external catheter, moisture barrier for incontinent episodes, repositioning every 2 hours, microclimate absorptive pad, and pillow.
On 5/12/19 at 8:00 PM, a preventive foam dressing was placed on Patient #4's sacrum due to redness.
Patient #4 was transferred to the Step-down unit on 5/13/19 at 2:57 PM.
The skin assessment dated 5/13/19 at 8:00 PM, revealed redness to Patient #4's groin and buttock. Interventions in place included purwick external catheter, repositioning, microclimate absorptive pad, barrier cream, and increasing mobility such as being up in the chair.
On 5/14/19 at 7:30 PM, the nurse documented moisture breakdown to buttocks and groin, sacrum red, but blanchable.
The GI (Gastrointestinal) OUTPUT Flowsheet documented episodes of incontinence on the following dates and times:
-5/14/19 at 7:30 AM
-5/15/19 at 7:30 AM
-5/15/19 at 8:00 PM
-5/16/19 at 8:00 PM
-5/16/19 at 11:14 PM
-5/17/19 at 1:00 AM
There was no documentation in the medical record barrier cream was applied after each of these incontinent episodes.
The Physician ordered a Wound Nurse Consult on 5/20/19.
The Wound Care Notes dated 5/21/19 at 8:46 AM, revealed "...diffuse area of incontinence-associated dermatitis to buttock and perineum...patient incontinent..."
2. In a telephone interview on 9/30/2020, the Administrative Director of Nursing, verified barrier cream should have been applied to Patient #4 after each incontinent episode and it should have been documented in the medical record.