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Based on medical record review, interview, governing board bylaws review, and governing board meeting minutes review revealed the provider failed to ensure a system was in place for the evaluation of patient safety had occurred while being transported to outside appointments for two of two sampled patients (5 and 7) who were cognitively impaired. Findings include:

1. Review of patient 5's medical record revealed:
*He had been admitted on 6/9/21.
*His diagnosis was critical illness myopathy and Charles Bonnet Syndrome (condition which causes a person whose vision has started to deteriorate to see hallucinations).
*He had poor memory recall, was alert and oriented to self, and had no safety awareness.
*He was a high risk for falls and had required the use of chair alarms for safety.
*He had no spontaneous movement of his left arm and required total staff support for transfers.
*He was cooperative, impulsive, and restless.
*He had been transported for an outside appointment.
*A staff member for the provider had not accompanied him on the transfer.

Interview on 7/8/21 at 1:10 p.m. with CNP H concerning patient 5 revealed. She would have expected staff to accompany the patient.

Refer to A385, findings A1 and A3.

2. Review of patient 7's medical record revealed:
*She had been admitted on 4/16/21.
*Patient had a diagnoses of acute systolic heart failure, bacteremia, and Covid-19.
*On 4/16/21 at 2:07 p.m. her adult admission assessment revealed she had poor decision making capabilities.
*She had previously tried to elope from the facility.
*Progress note on 4/22/21 at 9:08 a.m. by CNP M stated
* "She continues to have a near complete lack of insight into her safety, health, and wellbeing."
*Nurse's note on 4/23/21 at 2:40 p.m. stated patient returned from outside appointment.
*On 4/24/21 at 1:08 p.m. a progress note by CNP H stated patient eloped from an outside appointment.
-Patient is a huge elopement risk.
*Patient was discharged on 4/26/21 to a memory care unit.

Refer to A385, findings A2 and A3.

3. Review of the provider's 5/20/21 governing board body meeting minutes revealed:
*Patient safety discussion included:
-Medication reconciliation compliance.
-Opioid stewardship/pain management.
*No further safety concerns had been reviewed or identified.

4. Review of the provider's 2/17/21 governing board bylaws revealed it is the governing board's responsibility to:
-Implement and maintain a hospital wide program to assess, maintain, and improve the quality of patient care and safety.
-Ensure medical staff establishes and maintains written policy and procedures.

5. Interview on 7/9/21 at 1:48 p.m. with CEO C revealed the patient safety included in the governing board minutes only dealt with medication errors.

6. Interview on 7/9/21 at 2:10 p.m. with CEO C, CNO A, and quality risk director B revealed:
*CEO C was a governing board member.
Interview on 7/9/21 at 2:10 p.m. with CEO C, CNO A, and quality risk director B revealed:
*The provider had a wheelchair van.
*The van requires the staff to have certifications and training for the lift so it can not have been used all the time.
*The local wheelchair transportation company dropped the patient off at their outside appointments and delivered the paperwork.
*They would not have waited with the patient at the appointment, but would have sometimes waited in the parking lot for a short appointment.

Based on medical record review, interview, and medical executive committee meeting minutes review revealed the provider's medical staff failed to ensure a system was in place for the evaluation of patient safety had occurred while being transported to outside appointments for two of two sampled patients (5 and 7) who were cognitively impaired. Findings include:

1. Review of patient 5's medical record revealed:
*He had been admitted on 6/9/21.
*His diagnosis was critical illness myopathy and Charles Bonnet Syndrome (condition which causes a person whose vision has started to deteriorate to see hallucinations).
*He had poor memory recall, was alert and oriented to self, and had no safety awareness.
*He was a high risk for falls and had required the use of chair alarms for safety.
*He had no spontaneous movement of his left arm and required total staff support for transfers.
*He was cooperative, impulsive, and restless.
*He had been transported for an outside appointment.
*A staff member for the provider had not accompanied him on the transfer.

Interview on 7/8/21 at 1:10 p.m. with CNP H concerning patient 5 revealed. She would have have expected staff to accompany the patient.

Refer to A385, findings A1 and A3.

2. Review of patient 7's medical record revealed:
*She had been admitted on 4/16/21.
*Patient had a diagnoses of acute systolic heart failure, bacteremia, and Covid-19.
*On 4/16/21 at 2:07 p.m. her adult admission assessment revealed she had poor decision making capabilities.
*She had previously tried to elope from the facility.
*Progress note on 4/22/21 at 9:08 a.m. by CNP M stated
* "She continues to have a near complete lack of insight into her safety, health, and wellbeing."
*Nurse's note on 4/23/21 at 2:40 p.m. stated patient returned from outside appointment.
*On 4/24/21 at 1:08 p.m. a progress note by CNP H stated patient eloped from an outside appointment.
-"Patient is a huge elopement risk."
*Patient was discharged on 4/26/21 to a memory care unit.

Refer to A385, findings A2 and A3.

3. Review of the provider's 6/21/21 medical executive committee meeting minutes revealed:
*Physician J was a member of the medical executive committee.
*The meetings are held quarterly and the next meeting was scheduled for August.
*CNO A and chief executive officer (CEO) C were present at the meeting.
*Sentinel events for medication errors and falls had been discussed.
*No other areas of patient safety documented.

4. Interview on 7/9/21 at 2:10 p.m. with CEO C, CNO A, and quality risk director B revealed:
*The provider had a wheelchair van.
*The van requires the staff to have certifications and training for the lift so it can not have been used all the time.
*The local wheelchair transportation company dropped the patient off at their outside appointments and delivered the paperwork.
*They would not have waited with the patient at the appointment, but would have sometimes waited in the parking lot for a short appointment.

A. Based on medical record review, packet for appointment sheet review, and interview revealed the provider failed to ensure a system was in place for the evaluation of patient safety had occurred while being transported to outside appointments for two of two sampled patients (5 and 7) who were cognitively impaired. Findings include:

1. Review of patient 5's medical record revealed:
*He had been admitted on 6/9/21.
*His diagnosis was critical illness myopathy and Charles Bonnet Syndrome (condition which causes a person whose vision has started to deteriorate to see hallucinations).
*On 6/9/21 at 11:23 p.m. his adult admission assessment revealed:
-He had poor memory recall, was alert and oriented to self, and had no safety awareness.
-He was a high risk for falls and had required the use of chair alarms for safety.
*He had no spontaneous movement of his left arm and required total staff support for transfers.
*He was cooperative, impulsive, and restless.
*Certified nurse practitioner (CNP) H ordered a head computed tomography (CT) scan on 6/18/21 for vertigo and headache.
*The CT scan had been performed on 6/21/21 at an outside facility.
*On 6/21/21 at 10:00 a.m. physical therapy treatment recommendation that patient is significantly impacted by visual changes and is unable to do anything functionally because he feels like he is 'going backward' all the time.
*6/21/21 at 3:49 p.m. nurse's note by RN E stated visual hallucinations presents upon assessment. CNP H aware of status and will administer as needed to help vertigo symptoms present along with active hallucinations.
*6/21/21 at 3:14 p.m. physician progress note by physician J for mental status stated not oriented to person, place, and time.
*There was no documentation to support what documents and information had been sent with him to his appointment.
*There was no documentation the provider had contacted the outside facility to schedule the CT appointment.

Interview on 7/8/21 at 1:10 p.m. with CNP H concerning patient 5 revealed. She would have:
*Sent him in the ambulance.
*Expected staff to go with him since he had really bad problems with Charles Bonnett Syndrome.
*He was oriented to self only and could have told you what the information was at times
*Expected the physician to state mode of transfer and if staff should have accompanied patient.

Interview on 7/8/21 at 1:34 p.m. with RN E regarding patient 5 revealed:
*He had some hallucinations prior to going on appointment and had hallucinations when he came back.
*He was unable to walk.
*He was aware of self.
*He can tell you sometimes what the situation is, but that is the baseline.
*Facility staff could not have been accompanied the patients for outside appointments.

Interview on 7/8/21 at 2:10 p.m. with physician J revealed:
*Patient 5 was initially supposed to go via ambulance, but they would have had to wait 30 minutes.
*He stated "When sending people out the recommendation is how fast can we get the test done."

Interview on 7/8/21 at 2:30 p.m. with case manager N revealed:
*They had been watching patient 5 very closely for hallucinations and vertigo.
*An appointment should have been made for the outside appointment.
*They will document when an outside facility is contacted.
*Staff would not have went with patient when the local wheel chair company was used.

Interview on 7/8/21 at 7:45 a.m. and at 9:13 a.m. with chief nursing officer (CNO) A and quality/risk director B revealed:
*Patient 5 had a lot going on medically, but he was stable.
*CNO A had called the other provider the morning of the transfer, but had not documented the call.
*They had not made a policy for an outside appointment protocol or procedure.
*They used the packets for appointments sheet for a minimum set of information to be sent with patients.
*The hospital has a van, but they don't always have staff to drive the van.

2. Review of patient 7's medical record revealed:
*She had been admitted on 4/16/21.
*Patient had a diagnoses of acute systolic heart failure, bacteremia, and Covid-19.
*On 4/16/21 at 2:07 p.m. her adult admission assessment revealed she had poor decision making capabilities.
*On 4/19/21 another patient was being discharged from facility. Patient wheeled herself through the automatic doors and had to be brought back in by staff.
*Progress note on 4/22/21 at 9:08 a.m. by CNP M stated
- "She continues to have a near complete lack of insight into her safety, health, and wellbeing."
-Patient was not competent to make major medical and life decisions.
-"Care team has had multiple and recurrent discussions with her regarding her disposition. Her continued memory and judgement impairment is quite prominent during these discussions."
-Discharging her against medical advice ws not a safe option.
*Nurse's note on 4/23/21 at 2:40 p.m. stated patient returned from outside appointment.
*On 4/24/21 at 1:08 p.m. a progress note by CNP H stated:
-Patient eloped from an outside appointment.
-Patient had gotten into an unknown vehicle and left premises without taking ride back with local wheel chair transport company.
-Police were notified.
-Daughter found patient at home in her front yard.
-Patient was a huge elopement risk.
*Patient was discharged on 4/26/21 to a memory care unit.

Interview on 7/9/21 at 11:50 a.m. with CNP M revealed:
*Her understanding was the patient's daughter would have met the patient at the appointment.
*She had never seen a staff member accompany a patient to an appointment.
*She had not been involved with the arranging the transportation.

3. Review of the provider's undated Packet for Appointments sheet revealed:
*The following should be sent with a patient for an outside appointment:
-Patient facesheet.
-Service sheet (unless going to dialysis facility or riding in the provider's van.
-Copy of the medication administration record.
-"Sometimes providers will request progress notes to be sent with, depending on the appointment."


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B. Based on interview, record review, job description review, and policy review, it was determined the provider failed to ensure:
*The physician had been notified of a deep tissue injury (DTI) identified at the time of admission for one of one sampled resident (3).
*Interventions had been put in place for the treatment of a DTI when it had been identified for one of one sampled patient (3).
*A dietitian had assessed one of one sampled discharged resident (3) for a DTI and other medical concerns.
*The care plan had addressed a DTI and interventions for treating it for one of one sampled patient (3) with a DTI.
*A DTI had been assessed daily by a licensed professional for one of one sampled patient (3).
*A toileting program had been developed, followed, and care planned for one of one sampled patient (3) who was dependent on staff to assist with all activities of daily living (ADL).
*A repositioning schedule had been developed, followed and care planned for one of one dependent sampled patient (3).
*A DTI had not worsened for one of one dependent sampled resident.
Findings include:

1. Review of resident 3's closed medical record revealed:
*He was admitted on 6/18/21 for rehabilitation after a femur fracture.
*He had a significant history of cerebral vascular accident with left-sided weakness, cardiac arrest, cognitive impairment, pneumonia, cellulitis, and leg swelling.
*On the day of admission Wound Care Coordinator (WCC) D had assessed and photographed a 2 centimeter (cm) by (X) 3 cm unstageable deep tissue injury (DTI) on his right heel.
-The area was closed.
-The skin was purple in color and non-blanching.
*His Braden Pressure Ulcer Risk Assessment score was 15, indicating mild to moderate risk of pressure ulcers.
*Treatment suggested for a Braden score of 15 had been:
-A high specification foam mattress or air overlay.
-A chair cushion.
-A bed cradle.
-Repositioning weight.
-Skin inspections.
-Promoting activity.
-Managing risk factors such as:
--Nutrition.
--Friction.
--Continence.
--Education.
--Evaluating a change of condition.

On 6/18/21 registered nurse (RN) O completed an Adult Admission Rehab (rehabilitation) Assessment for patient 3. The assessment:
*Included a nutrition assessment indicating:
-His malnutrition score was zero.
-He had no weight loss or change in appetite.
-He had used a regular diet at home.
*There was no skin assessment done as part of her assessment.
*His Brief Interview for Mental Status evaluation score was 14, indicating his cognition was intact.
*He was dependent (Helper does all the effort/Patient does none of the effort) on staff for:-Rolling side to side in bed.
-Sitting to lying.
-Lying to sitting and sitting to standing.
-Being transfer to the bed, chair, and toilet.
*He could not walk.
*He was always incontinent of urine.
*His bowel continence was not rated.
*He had one unstageable deep tissue injury.

Review of physician J's 6/18/21 Rehabilitation Consult regarding patient 3 revealed:
*He would require medical management with multidisciplinary care including "a dietitian input regarding diet and strengthening with increased protein."
*A physical examination included:
-No lesions or rashes.
-His left lower extremity had two plus edema.
-"Consult dietitian."
-"Skin care protocol, wound care consulted."
-There was no documentation of a DTI.

Review of patient 3's 6/18/21 Interdisciplinary Plan of Care (IPOC) revealed he was at risk for skin breakdown.
*The goal was for his skin to remain intact without evidence of skin breakdown. Interventions included:
-Encouraging adequate hydration and nutrition.
-"Evaluate patients who are chair fast for appropriate chair cushion."
-"Encourage patient to reposition while in bed."
*There was no indication patient 3 had a DTI.
*There were no interventions specific to the DTI.
*There was nothing in the care plan about consulting a dietitian or a wound care consultant.

Review of patient 3's physician's orders revealed:
*On 6/17/21:
-Daily dressing change to his hip incision as needed.
-Intake and Output.
*On 6/19/21: Below the knee graduated compression stockings.
*On 6/20/21: Lasix 40 milligrams daily for his leg swelling.
*On 6/21/21:
-A wound consult.
-Heel pillows.
-Optifoam dressing to his right heel.
*There was no physician's order for a dietitian consult.
Review of the 6/18/21 through 6/24/21 DTI skin assessments revealed no assessments had been completed on 6/19/21 or 6/20/21.

Interview on 7/8/21 at 8:45 a.m. with WCC D regarding resident 3's DTI revealed:*She assessed it on 6/18/21 at the time of his admission.
*The skin was intact, purple, and non-blanching.
*Her plans were to order heel boot lifts to keep pressure off the heel, and an air mattress.
*She confirmed she:
-Had not left orders for the DTI treatment until she returned to work on 6/21/21.
-Had left the DTI uncovered and unprotected.
-Had not notified the physician of the DTI.
-Had expected a nurse to assess the DTI every day.
-Should had left orders for the treatment of the DTI at the time she had assessed the wound.
-Patient 3's DTI had increased in size from 2cm X 3cm on 6/18/21 to 2cm X 4.2cm on 6/23/21.

Review of a 6/19/21 initial evaluation by RN case manager N in a conversation with patient 3 revealed the patient had been incontinent of urine after waiting for staff to toilet him.

Interview on 7/8/21 at 11:00 a.m. with chief nursing officer (CNO) A revealed:
*There were no policies or protocol for routine toileting or repositioning for patients who could not have done it independently.
*The patients were there for rehabilitation with a plan to return home again.
*Patients who were able to talk were expected to tell the staff if they needed help regardless of their need for extensive physical assistance.
*The patients would need to ask for help if they had required assistance at home.

Further interview with CNO A at the above time regarding patient 3 revealed:
*She had:
-Been working on 6/20/21 when the family had been upset about the patient being in his wheel chair (w/c) for hours.
-Taken the resident to his room a number of times to change his brief.
*The patient was encouraged to off-load in his w/c using his feet to push himself up.
-He was able to make slight repositioning changes independently.
*She:
-Was aware of his dependence on assistance from staff.
-Had not documented the times she had taken the patient to his room to change his brief.
-Agreed if there was no documentation the task would not have been done.

On 7/8/21 CNO A provided a 3/17/21 Bladder Policy indicating:
*It was the responsibility of licensed staff to set up a bladder program for each patient with impaired bladder elimination.
*The purpose of the program was to:
-Prevent skin irritation and skin breakdown.
-Improve the morale of the patient.
-Restore the patient's:
--Dignitiy and self-esteem.
--Fullest capacity.
-Instruct the patient in self care.
*"It is the policy of this hospital to engage in a bladder program on all adults who may be physically or cognitively capable of obtaining bladder control."

Interview on 7/9/21 at 2:00 p.m. with charge nurse G and rehabilitation nursing technician (RNT) I regarding toileting and repositioning patients revealed:
*RNT I stated:-Patients should have been toileted or checked for incontinence at least every two hours.
-The repositioning of the patient would have occurred after the toileting had been completed.
-There was no specific area to document when a patient had been toileted or repositioned.
*Charge nurse G stated:-Documenting routine toileting or repositioning was not an expectation of the staff.
-When the staff identified a patient who had required routine toileting or repositioning, the nurse could have entered that task into the chart.
--That gave the staff the capability to document it in the patient's chart when it had occurred.
--It would not have been in their record unless the nurse had specifically entered the task.

Interview on 7/8/21 at 2:15 p.m. with physician J regarding patient 3's DTI confirmed he:
*Was not aware the patient had a DTI.
*Should have been notified of it.

Interview on 7/9/21 at 8:30 a.m. with WCC D and CNO A regarding dietitian involvement with patient 3 revealed:
*A dietitian was not always utilized for patients with pressure ulcers.
*It was up to the physician if the dietitian would be involved.*The dietitian would have been involved with stage 3 or 4 pressure ulcers only.
*The policy had not specified dietitian involvement for DTIs.

Interview on 7/9/21 at 10:30 a.m. with dietitian F regarding patient 3 revealed:*She had recalled the patient but had not been involved with his care.
*She was unable to remember if she had attended his 6/21/21 care conference.
-She normally attended all care conferences.
*She would only consult with a resident if the physician had requested it.
-She had not received a consult order from the physician.
*If there was a reason for her to consult with a patient the electronic medical record would have flagged her to let her know.
-The EMR had not flagged her for the patient.

Review of the provider's November 2020 Pressure injury Prevention/Basic Treatment policy revealed:*Basic prevention measures would be implemented to prevent and treat pressure injuries.
*Protocols did not take the place of individualized treatment plans in more complicated wounds such as stage 3 or 4 pressure ulcers.
*"Establish a regular positioning schedule for patients who are unable to manage pressure relief independently or need assistance with cueing."
*"Limit the time the patient spends seated in a chair without pressure relief seating support."
*Document repositioning to include frequency and position."
*"Evaluate and treat urinary/fecal incontinence."
*"When moisture/incontinence can not be prevented or controlled apply a barrier cream. Use an underpad or briefs...being careful to conduct frequent checks for soiling."
*"Optimize the patient's nutritional status."

Review of the provider's June 2021 Wound assessment and Documentation policy revealed:
*"An RN will inspect each patient's integument daily and as often as indicated."
*Daily documentation of skin and wound inspection completed by an RN would include the skin condition, dressing integrity, and description of the wound.
*"The physician assumed leadership over clinical interventions and wound care treatment."
*"The wound care coordinator has the responsibility for oversight of the wound program."

Review of the provider's March 2020 Nutritional Assessment, Reassessment, and Care Planning revealed:
*Upon receipt of an order for nutritional consultation the registered dietitian would initiate a nutritional assessment.
*Based on the findings the registered dietitian would establish the nutrition care pan for the patient that identified goals, recommended specialized nutrition care modalities, and determined the frequency of follow up.

Review of the provider's March 2020 Nutritional Screening policy revealed:*If a patient was found to be at nutritional risk in the course of nutritional screening a request was to have been made for comprehensive nutritional screening.
*If the nutrition screen indicated a nutritional assessment needed to be completed an order would be obtained for the assessment and dietary department would receive a notification of the order.

Review of the provider's August 2020 Care Planning policy revealed:
*Each patient admitted would have an IPOC developed based on their assessed individual needs, physical, cognitive, and functional impairments, and co-morbid conditions.
*Each body system or functional area with identified problems would be followed by specific interventions designed to meet the needs of the patient.


C. Based on record review, interview, and job description review, the provider failed to follow physician's orders for measuring intake and output (I and O) for one of one sampled patient (3) receiving a diuretic for edema. Findings include:

1. Review of resident 3's closed medical record revealed:
*He:
-Was admitted on 6/18/21 for rehabilitation after a femur fracture.
-Had a significant history for cerebral vascular accident with left-sided weakness, cardiac arrest, cognitive impairment, pneumonia, cellulitis, and leg swelling.
*Review of his physician's orders revealed:
-6/17/21: "Intake and output every eight hour shift."
-6/17/21: "Notify provider if weight greater than 3 pounds from prior weight or five pounds from seven days."
-6/19/21: Lasix 40 milligrams (mg) one time only.
-6/19/21: Below the knee graduated compression stockings.
-6/20/20: Lasix 40 mg changed to daily.

Review of the I and O documentation from 6/18/21 through 6/24/21 revealed:*6/18/21: Total intake: 400 milliliters (ml)
*6/18/21: Total output: No documented output results for date range.
*6/19/21: Total intake: 860 ml.
*6/19/21: Total output: No documented output results for date range.
*6/20/21: Total intake: 640 ml.
*6/20/21: Total output: 150 ml.
*6/21/21: Total intake: 980 ml.
*6/21/21: Total output: 1050 ml.
*6/22/21: Total intake: 240 ml.
*6/22/21: Total output: No documented output results for date range.
*6/23/21: Total intake: 730 ml.
*6/23/21: Total output: No documented output results for date range.
*6/24/21: Total intake: 500 ml.
*6/24/21: Total output: No documented output results for date range.

Review of patient 3's bowel and bladder flowsheet documentation revealed:
*6/18/21: One void - in urinal: "None."
*6/19/21: Four voids, all incontinent in brief.
*6/20/21: Three voids: Two in bedside commode. All voids had been incontinent.
*6/21/21: Six voids: Four continent, two incontinent. Output was 1050.
*6/22/21: Two voids, both incontinent.
*6/23/21: Three voids, no documented output.
*6/24/21: Two voids, both incontinent.

Interview on 7/8/21 at 8:45 a.m. with the CNO regarding patient 3's I and O documentation revealed:*She confirmed the I and O:
-Was difficult to follow.
-Had very few actual documented output measurements.
-Was incomplete.
*Stated the I and O was not made for the nursing department to document.
-The nursing department was the only department responsible for collecting I and O measurements.
*The provider had no policies or protocol for performing I and O.

Interview on 7/8/21 at 2:15 p.m. with physician J regarding patient 3's I and O confirmed:
*He had ordered I and O for the patient.
*The I and O was inaccurate.
*He had:
-Instructed the patient that I and O would be useless without a catheter.
-Not discontinued the I and O.

2. Review of the provider's undated chief nursing officer (CNO) job description revealed:
*The CNO was responsible for the development and implementation of the plans for providing nursing care, treatment, and services, "including determination of types and numbers of nursing personnel necessary to provide nursing care and the development of a patient focused, team oriented culture, working in conjunction with all other medical, clinical and therapeutic disciplines to ensure optimal service and superior outcomes."
*The CNO held full responsibility for the quality of nursing care provided.
*Essential job functions had included:-Developing patient care programs, policies, and procedures that described how patients' needs for nursing care, treatment and services were assessed, evaluated, and met.
-Developed and implemented the plans for providing nursing care, treatment, and services to provide nursing care.
-Supervised and coordinated nursing personnel and the delivery of nursing care and that all patient activities were completed as required.
-Actively participated as a member of the hospital's Governing Body, Quality Council, Med Exec, Infection Control, Education, and Ethics committees.
-Collaborated with nursing peers, the interdisciplinary team and others who influenced healthcare.
-Identified training needs and resources for staff with other organizational leaders.

Review of the undated Wound Care Nurse job description revealed:*The wound care nurse was to have provided wound care services applicable federal, state, regulatory, and company standards to ensure the delivery of quality patient care was rendered at all times.
*The Plan of Care and physician orders were to have been followed with regard to wound care treatments.
*The wound care nurse:
-Functioned under the direction of an RN or physician demonstrating communication skills, personal integrity, and working effectively with patients, family members, physician, staff, and outside agencies as required.
-Lead hospital wound education efforts, as well as well as patients and family members on wounds and wound care topics.
-Guided the clinical team on wound care treatment.
-Assisted with wound evaluation and the development of an appropriate plan of care for wounds.
-Initiated wound care regimen.
-Documented patient care problems and progress.
-Reviewed and recommended changes to the wound plan on a regular basis.
-Analyzed the patient's wound's condition and reported abnormal findings to the RN and physician.
-Ordered appropriate wound care equipment.
-Facilitated the identification, staging, and documentation of wounds as required by the CMS Quality reporting program.
-Assisted with wound evaluation and the development of an appropriate plan of care for wounds.