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Based on interview, record review, and policy review it was determined the facility failed to ensure Nursing Services supervised the nursing care for one of thirty patients (Patient #1). According to documentation in the medical record, Patient #1 had an ulcer/wound upon admission to the facility. However, Nursing Services failed to obtain a wound/nutritional consultation for Patient #1, who had actual alteration in skin integrity, in accordance with facility policy.

The findings include:

Review of the facility policy titled "Provide and maintain skin integrity," dated June 2012, revealed the facility had systems/procedures in place for Nursing to conduct risk assessments and reassessments using the Norton Risk Assessment Tool (skin assessment/screening tool). According to facility policy, the Norton Risk Assessment Tool was used to perform reassessments of risk factors on each inpatient every shift or with any significant change in the patient's condition. Further review of the policy revealed the nurse was to obtain a wound/nutritional consultation for those patients who had actual alteration in skin integrity.

Review of the medical record revealed the facility admitted Patient #1 on 07/13/12, with diagnoses that included Diabetes, Deep Vein Thrombosis, and Ulcer/Wound of the left lower leg. Review of the initial nursing assessment revealed Patient #1's left lower extremity wound had "weeping edema with open skin." Further review of the Norton Risk Assessment revealed the patient triggered a nutritional consultation but there was no evidence that a nutritional consultation had been conducted.

An interview was conducted on 07/16/12, at 2:15 PM, with the Nurse Manager who confirmed a nutritional consultation should have been made for Patient #1 at the time of admission. The Nurse Manager stated the admission nurse "failed to follow protocol."

A telephone interview was conducted on 07/17/12, at 6:00 PM, with the admissions nurse who stated Patient #1's initial assessment/Norton Skin Assessment had triggered a nutritional consultation. According to the admissions nurse, another nurse (Nurse #1) began the assessment and the admissions nurse assumed the nutritional consultation had already been made by Nurse #1.

Nurse #1 was not available for interview at the time of the survey.