HospitalInspections.org

Based on observation, interview, and record review the facility failed to ensure that an RN supervised and evaluated the care for 6 of 8 sampled patients assessed as " at risk " for skin breakdown:

3 of 8 sampled patients failed to have preventative measures implemented per policy until after a skin problem occurred (Patient ID # 4, # 10, # 11).

5 of 8 sampled patients assessed " at risk " did not have " skin breakdown " addressed on their care plan (Patient ID # 1, # 3, # 4, # 11, # 12).

Findings include:

TX # 00178591

Patient # 4:

Record review of Patient # 4 ' s clinical record revealed she was 98 years old and admitted on 07-15-13 for Pneumonia. On admission her Braden Skin Assessment Score was 15 (at risk for skin breakdown). Further review of Patient # 4 ' s care plan failed to reveal ' potential skin breakdown ' identified as a problem.

Observation on 07-18-13 at 10:15 a.m., with staff assistance, observation was made of redness to patient # 4 ' s coccyx. The Director of Nurses (DON) # ID # 2 stated at the time of observation " she should have had an egg crate mattress already. "

Patient # 10:

Record review of Patient # 10 ' s clinical record revealed he was 84 years and admitted on 04-18-13 with rib fracture and right shoulder injury secondary to a fall. On admission his Braden Skin Assessment Score was 18 (at risk for skin breakdown). Further review of Patient # 10 ' s care plan failed to reveal ' potential skin breakdown ' identified as a problem.

Further review of the clinical record revealed that an "egg crate ' foam mattress was provided on 04-21-13, after there was redness noted to patient # 10 ' s heel and sacrum.

Patient # 11:

Record review of Patient # 11 ' s clinical record revealed she was 94 years and admitted on 04-18-13 with a fractured arm. On admission her Braden Skin Assessment Score was 18 (at risk for skin breakdown). Further review of Patient # 11 ' s care plan failed to reveal ' potential skin breakdown ' identified as a problem.

Further review of Patient # 11 ' s clinical record revealed that an " egg crate ' foam mattress was provided on 04-21-13, after there was redness noted to Patient # 11 ' s coccyx.

Patient # 1:

Record review of Patient # 1 ' s clinical record revealed she was 90 years and admitted on 07-12-13 with a diagnosis of Pneumonia. On admission her Braden Skin Assessment Score was 17 (at risk for skin breakdown). Further review of Patient # 1 ' s care plan failed to reveal ' potential skin breakdown ' identified as a problem.

Patient # 3:

Record review of Patient # 3 ' s clinical record revealed he was 92 years and admitted on 07-16-13 with a diagnosis of Acute Renal Failure. On admission her Braden Skin Assessment Score was 12 (high risk for skin breakdown). Further review of Patient # 3 ' s care plan failed to reveal ' potential skin breakdown ' identified as a problem.

Patient # 12:

Record review of Patient # 12 ' s clinical record revealed he was 82 years and admitted on 03-27-13 with a diagnosis of Metatarsal Ulcer. On admission his Braden Skin Assessment Score was 10 (high risk for skin breakdown). Further review of Patient # 12 ' s care plan failed to reveal ' potential skin breakdown ' identified as a problem.

Interview on 07-18-13 at 2:45 p.m. with the DON (ID # 2) she stated that a patient skin assessment was performed on admission and at least once per shift. The facility used the Braden Scale Skin Assessment to determine degree of patient risk for skin breakdown. Based on the numerical Braden score, patients were assessed as at Risk (15-18); Moderate Risk (13-14 points); and High Risk (12 points or less). The DON (ID # 2) went on to say per policy, each risk level had specific skin breakdown preventative measures to be implemented. In addition, all patients identified at risk for skin breakdown should have this addressed as a problem on their care plan

Review of facility policy titled " Pressure Ulcer Protocol, reviewed 12/09, read: " The Braden Ulcer Risk Assessment will be performed by an RN on every adult patient admitted to the hospital ...Purpose: to identify on admission patients who are at risk of developing a pressure ulcer ...,maintain and improve tissue tolerance ...in order to prevent injury ... "

Review of facility policy tilted " Nursing Problem List, " reviewed 04/12, read: " A Nursing Problem List (Care Plan) is documentation of the application of the nursing process to identify patient problems and formulate a plan to resolve those problems.. the problem list will be based on assessment to include ...physical status ...and past health history ... "