HospitalInspections.org

Based on document review and interview, the facility failed to properly provide the "Important Message from Medicare" for 5 of 8 patients (#1,#2, #3, #6, and #8) with Medicare coverage and length of stays greater than 96 hours, resulting in the denial of the rights of Medicare patients to appeal their discharge from the facility. Findings include:

1.) On 9/20/2022 at 1400 the document review of patient #1's medical record found no "Important Message from Medicare" (IMM) was in the record.
2.) On 9/20/2022 at 1407 the document review of patient #2's medical record included an IMM. However, the patient was admitted on 9/9/22 and the IMM was signed and dated greater than 48 hours after admission on 9/12/22.
3.) On 9/20/2022 at 1415 the document review of patient #3's medical record included an IMM. However, the patient was admitted on 9/16/22 and the IMM was signed and dated greater than 48 hours after admission on 9/21/22.
4.) On 9/20/22 at 1428 record review of patient #6 revealed no IMM.
5.) On 9/21/22 at 1436 record review of patient #8 revealed no IMM.

On 9/21/22 at 1500 during an interview Staff E confirmed the above findings and stated, "we have a new EMR and are still working through some things, this will have to be looked at immediately.".

Review of the facility policy titled, "Medicare Important Message delivery,"effective date 07/01/07, review date 08/31/22, revision 08/31/22 revealed the following under 4.1 "Medicare and medicare advantage inpatients will receive an IM (Important Message from Medicare) at the time of admission, or no later than two days after admission to a hospital inpatient bed. The patient should sign, date, and time when they receive the IM in the appropriate area of the IM. If the patient refuses to accept the IM, the house representative should make a note of this, along with the date and time, in the additional information area. The patient and the representative should sign all IMs. A copy should be given to the patient and the original should accompany the medical record to the nursing unit..."

Based on document review and interview the facility failed to implement and follow the nursing care plan and the facility's policy regarding skin care, and wound prevention, for one (patient #1) of three patients at risk for developing pressure wounds, resulting in the potential for less than optimal outcomes for patients with integument concerns. Finding include:

On 09/21/2022 at 1230 during the medical record review for Patient (Pt)#1 it was revealed that Pt #1 was admitted to the hospital via the emergency room on 1/21/2022." The medical record revealed no documentation of wounds on the initial nursing assessment. It was however documented that Pt #1 developed a pressure wound located in the coccyx area during the course of his stay at the facility.

*The following dates and times indicate no documentation of turn/reposition

02/03/22 0600 - 0000 = 18 Hours with no reposition documentation
02/04/22 0800 - 2000 = 12
02/06/22 1900 - 2300 = 4
02/07/22 1600 - 2000 = 4
02/08/22 0600 - 0000 =18
02/09/22 0000 - 1400 = 14
02/10/22 0600 - 0900 = 3
02/11/22 0600 - 0900 = 3
02/12/22 1600 - 2000 = 4
02/13/22 0000 - 0500 = 5
02/13/22 0500 - 2000 = 15
02/14/22 0600 - 1100 = 5
02/14/22 1300 - 2200 = 9
02/14/22 - 02/15/22 2200 - 0800 = 10

On 09/21/2022 at 1345 during an interview, Staff E (Director of Nursing) was queried if turning and repositioning of the patient should be included in the documentation of nursing care. Staff E stated that the expectation is for staff to document repositioning of the patient every two hours minimally. Staff E was then asked if documentation had been completed every two hours for Pt #1 for repositioning. Staff E stated, "No."

On 09/21/2022 at 1350 a review of the policy titled, "Skin Care, Wound Prevention and treatment Guidelines," policy number PC-290, effective date March 1993, last revised date March 22 2022 . On page 4/12 5.1.4.1 "Reduce or alleviate pressure: Position the patient to minimize pressure; turn every two (2) hours or more if condition indicates; encourage the patient who can self turn to turn at least every two (2) hours; Avoid laying directly on hip/thigh with bony prominence; pad skin adjacent to medical device; ambulate; use pillows, wedges and heel boots appropriately; ..."