The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

ANNA JAQUES HOSPITAL 25 HIGHLAND AVENUE NEWBURYPORT, MA 01950 June 29, 2011
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on record review and staff interview, the Hospital failed to ensure that nursing staff appropriately assessed and implemented intervnetions regarding pressure ulcers in a timely manner for 4 of 10 applicable patients (Patients #1, #2, #7, and #9).

adequately supervise and evaluate the care provided to each Patient #1 and #7 in June and March 2011 respectively.

Findings included:

1) PATIENT #1:
Review of medical record documentation indicated that on June 16,2011 Patient #1 was admitted to the Hospital with a low sodium level and a urinary tract infection. Patient #1's medical history was significant for Type II Diabetes, quadriplegia, long-term Foley catheter use, and Stage IV pressure ulcers.

Review of medical record documentation indicated was followed by the Wound Healing Center for pressure ulcer treatment. Documentation from the center dated 05/18/11, indicated Patient #1 had a Stage IV left trochanteric pressure ulcer measuring 4.0 centimeters by 2.7 centimeters by 0.2 centimeters and a Stage IV pressure ulcer located on the right ischial area measuring 3.0 centimeters by 1.0 centimeters by 0.1 centimeters .

Review of Patient #1' admission nursing assessment dated [DATE] at 6:20 AM, indicated Patient #1 had a dressing on the left hip. There was no documentation regarding Patient #1's right ischial pressure ulcer. There was no documented staging nor appropriate measurement of either pressure ulcer.

Continued review of Patient #1's medical record indicated on 06/16/11, Registered Nurse #2 documented on 06/16/11 at 8 PM a wet to dry dressing was applied to the half dollar size area on the left hip and right quarter size right hip area.

Continued review of the medical record indicated Patient #1 was not provided with either a specialized bed or mattress for the approximate 12 hours in the Intensive Care Unit or on transfer to a medical surgical unit where Patient #1 remained for the next 16 hours until discharge to the community with home health services.

Registered Nurse #2 was interviewed on 06/29/11 at 1:30 PM. Registered Nurse #2 said no treatment was provided to Patient #1's pressure ulcers since admission 14 hours earlier. RN #2 was not able to describe the affected areas as to the specific staging, appearance nor measurement in centimeters. Registered Nurse #2 said Patient #1 was not provided with a specialized mattress to prevent further skin breakdown.

2) PATIENT #2:
Review of medical record documentation indicated Patient #2 was admitted on [DATE] with a Stage IV pressure ulcer that was treated by the Wound Healing Center.

Review of the Admission Nursing Assessment date 1/4/11, indicated there was no nursing assessment for the specific appearance, staging,and measurement of Patient #2's pressure ulcer.

3) PATIENT #7:
Review of medical record documentation indicated Patient #7 was admitted on [DATE] from a long-term care facility with a coccyx wound. There was no specific documented appearance, staging or measurement of Patient #7 wound on admission.

Review of the Nursing Assessments dated 03/18/11, indicated the Stage IV coccyx wound packing and dressing were intact. There was no previous documentation for the assessment of Patient #7's wound.

Nursing documentation dated 03/19/11, indicated Patient #7 had a old wound packing with foul yellow yellow/green drainage and outer dressing saturated with serous drainage. The Nursing Note indicated wound base had thick yellow exudate and beefy red edges. A wound VAC (vacuum placed into a wound with a large amount of drainage) was applied.

The nursing staff failed to adequately assess, clearly identify and document the appearance, staging and measurement for patients with pressure ulcers at the time of admission.

4) PATIENT #9:
Review of medical record documentation indicated Patient #2 was admitted on [DATE] with a left ischial pressure ulcer that was treated by the Wound Healing Center.

Review of the Admission Nursing Assessment date 5/23/11, indicated there was no nursing assessment for the specific appearance, staging,and measurement of Patient #2's pressure ulcer.

The nursing staff failed to adequately assess, clearly identify and document the appearance, staging and measurement for patients with pressure ulcers at the time of admission.