HospitalInspections.org

Based on policy and procedure review, medical record reviews, and staff interviews, the facility staff failed to perform ADL's (activities of daily living) for 2 of 2 patients reviewed with impaired mobility (#8), failed to identify skin changes in 1 of 1 sampled patients (#8) and failed to turn and reposition 2 of 2 sampled patients (#8, #11).

The findings included:

Review of the hospital policy titled, "Perineal/Vaginal/Meatal/Incontinence Care and Treatments", last revised on February 2017 revealed, "...POLICY...1) Perineal Care is provided for the bedfast patient at least every shift and prn [as needed]..."

Review of the hospital policy titled, "Hair Care - Shampooing With or Without Tray", last revised on April 2018 revealed, "...PROCEDURE...1) The Licensed Nurse...Nursing Assistant will administer hair care when appropriate..."

Review of a hospital policy titled, "Skin Wound Care" last revised on September 2019 revealed, "...POLICY...8) A patient at risk (Braden Score < [less than/equal to 18] ) or with a pressure injury should have...nursing interventions implemented ...High Risk Skin Care Prevention Protocols ...2) Bathe patients gently using mild soap and water and pat dry ...7) Patients' position should be changed every two hours when in bed and every one hour when in chair...10) Offload heels from mattress ..."

Review of hospital procedures titled "Bed bath" last revised on May 21, 2021 revealed, "...Introduction: Performing a bed bath not only cleans a patient's skin but also stimulates circulation, provides mild exercise, and promotes comfort...Daily bathing with chlorhexidine-impregnated disposable cloths can help prevent such hospital-acquired infections...Documentation: Record the date and time of the bed bath..."

1. Review on 08/24/2021 of the closed medical record for Patient #8 revealed an 87-year-old female arrived at the named hospital on 02/18/2021 at 1031 with a chief complaint of Oliguria (decreased urine production and output). Review of the History and Physical (H&P) signed by AGNP (adult geriatric nurse practitioner) #1 at 1426 revealed, Patient #8 was "...urinary incontinent and wears a brief at baseline...Physical Examination...obese...LLE [left lower extremity] immobilizer in place ..." Review revealed Patient #8 had impaired mobility. Review of the Nursing Hygiene Flowsheets failed to reveal documentation that Peri-Care was completed for Patient #8 every shift per policy. Review of the Hygiene Flowsheets failed to reveal documentation that Patient #8 received a full bed bath or had her hair washed for 7 of 7 days hospitalized. Additionally, the Hygiene Flowsheets failed to reveal documentation that Patient #8 refused to have a bath or have her hair shampooed. Review of the Nursing Flowsheets revealed Patient #8's Braden Scale Score was documented as 13-18 (at risk to moderate risk) during hospitalization. A review of the Mobility Flowsheets revealed Patient #8 was only intermittently repositioned throughout her hospital stay. Record review failed to reveal documentation that Patient #8 was turned or repositioned every 2 hours per the skin care prevention protocols. Review of the Integumentary Flowsheets from 02/18/2021 through 02/23/2021 revealed a DTI (deep tissue injury) to Patient #8's right buttocks and a DTI to Patient #8's right heel. Review of the Integumentary Flowsheet completed by RN #6 on the day of Patient #8's discharge (02/24/2021) revealed, "...3 stage 2's to sacrum..." at 0930 and at 1824 revealed, "...yeast noted under both arms, under both breasts..." Review failed to reveal any sacral wounds or skin changes under Patient #8's arms and breast prior to 02/24/2021. Review of the Discharge Instructions signed by RN #6 on 02/24/2021 revealed, Patient #8 was discharged back to home at 2120.

Interview on 08/25/2021 at 1031 with NM (nurse manager) #9 revealed, the expectation that nurses provided or at least offered a patient a bath daily. NM #9 stated the daily bath included hair washing and a linen change when a patient allowed. NM #9 stated the nurses were expected to document when a patient refused. NM # 9 revealed nurses were expected to look under wound dressings when assessing a patient's skin in order to identify skin changes. Interview further revealed an expectation that patients were turned or repositioned every 2 hours when unable to perform on their own. Interview revealed the hospital policy was not followed.

2. Review on 08/26/2021 of the open medical record for Patient #11 revealed an 86-year-old female admitted at the named hospital on 08/10/2021 at 0634. Review of the History and Physical (H&P) initiated by MD #12 at 1116 revealed, Patient #11 underwent surgical repair for a hip fracture on 07/25/2021 and returned to the hospital on 08/10/2021 for a revision of that initial total hip replacement. Review revealed Patient #11 had impaired mobility. Review of the Nursing Flowsheets revealed Patient #11's Braden Scale Score was documented as 13-15 (at risk to moderate risk) from 08/11/2021 through 08/18/2021. Review of the Hygiene Flowsheets failed to reveal documentation of a daily bath for 5 of 15 days since admission and failed to reveal documentation of Patient #11's hair being washed or documentation of her refusal for 15 of 15 days. Review of the Mobility Flowsheets during the same week revealed, Patient #11 was only intermittently repositioned. Review failed to reveal documentation that Patient #11 was turned or repositioned every 2 hours per the skin care prevention protocols. Review revealed Patient #11 was a current inpatient and had not yet been discharged.

Interview on 08/25/2021 at 1031 with NM (nurse manager) #9 revealed, the daily bath included hair washing and a linen change when a patient allowed. NM #9 stated the nurses were expected to document when a patient refused. Interview further revealed an expectation that patients were turned or repositioned every 2 hours when unable to perform on their own. Interview revealed the hospital policy was not followed.

NC00174959