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Based on review of documentation, interviews and review of the prior statement of deficiencies, (reference 9BHB11), the Hospital had not developed/implemented an effective corrective action plan related to care of pressure ulcers.

Findings included:

1) Review of the Hospital Skin Care Policy, section titled 5. "Standards" indicated that a skin/wound assessment encompasses a complete full body skin inspection (head to toe) to detect any wounds and/or pressure ulcers already present. The Braden Scale is used to assess risk factors on admission and daily. Section 6. titled "Procedure" point 1. Document and describe all existing pressure ulcers/wounds on admission: include location, size, color and odor.

Review of Patient #2's medical record indicated the Patient was admitted on 6/30/10 for abdominal surgery.

Review of Patient #2's medical record indicated the Patient did not receive an admission skin/wound assessment on admission [which Hospital Administration accepts as being conducted within 24 hours of admission].

2) Interview with the Risk Manager and the Vice President for Patient Care Services/ Chief Nursing Officer on 8/10/10 indicated the Skin Care Policy was revised as a component of the plan of correction for CMS case reference 9BHB11 to include the full body inspection.

Based on a tour of the Intensive Care Unit [ICU], review of documentation and interviews, and clinical review of pressure ulcer care provided to Patient #1 and Patient #2, it was determined that the nursing staff did not consistently document a complete full body assessment on admission and document the status of the patient's pressure ulcer based on the Braden skin assessment scoring system on admission and daily.

Findings included:

1) Review of the Hospital Skin Care Policy, section titled 5. "Standards" indicated that a skin/wound assessment encompasses a complete full body skin inspection (head to toe) to detect any wounds and/or pressure ulcers already present. The Braden Scale is used to assess risk factors on admission and daily. Section 6. titled "Procedure" point 1. Document and describe all existing pressure ulcers/wounds on admission: include location, size, color and odor.

Review of Patient #2's medical record indicated the Patient was admitted on 6/30/10 for abdominal surgery.

Review of Patient #2's medical record indicated the Patient did not receive an admission skin/wound assessment on admission [which Hospital Administration accepts as being conducted within 24 hours of admission].

2) Review of the Wound/Skin Assessment dated 7/1/10 at midnight indicated the Patient's Braden score was assigned as 14, but there was no documentation regarding a wound/skin assessment or presence of a pressure ulcer. Review of documentation on 7/2/10 at 8 pm indicated the presence of a pressure ulcer on the posterior coccyx with additional narration that the duoderm dressing was in place, will remove and assess. The pressure ulcer was not assessed and staged at that time.

Review of the Skin/Wound Assessment Nursing Note dated 7/3/10 at 4:30 am indicated the dressing was changed and the pressure ulcer on the posterior coccyx was assessed as a Stage II [the same as reported by the receiving facility at time of discharge to the Hospital].

Review of documentation on 7/14/10 at 5:21 pm by the Wound Care Nurse indicated the presence of an Unstagable wound 9x7 that was 60% necrotic; 30% red; 10 % yellow. Santyl cream to pressure ulcer was recommended.

The pressure ulcer was determined to be Unstagable until the time of discharge on 7/20/10.