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.
|STATEN ISLAND UNIVERSITY HOSPITAL||475 SEAVIEW AVENUE STATEN ISLAND, NY 10305||Sept. 30, 2015|
|VIOLATION: NURSING CARE PLAN||Tag No: A0396|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interview, review of medical record and other documents, it was determined in one (1) of eight (8) medical records; nursing staff did not implement the facility's policy for the management of patients with pressure ulcer.
Patient A is a [AGE]-year-old female who was admitted on [DATE] after a cardiac arrest and fall at home. The patient suffered anoxic brain injury and was managed in the Critical Care Unit.
The initial nursing assessment of the patient on 6/30/14 at 6:00 PM described patient's skin as intact, cold, and mottled. She was identified as a high risk for the development of pressure ulcers evidenced by a Braden Risk Assessment (clinical tool used to assess risk of a patient/client developing a pressure ulcer) score of 12.
A stage II pressure ulcer (Partial thickness skin loss involving epidermis, dermis, or both) was identified on the patient's sacral spine on 7/17/14 that deteriorated to an unstagable pressure ulcer (Full thickness tissue loss where enough of the base of the wound is covered with slough or eschar) on 7/28/14. There was no evidence in the medical record of physician involvement in the assessment and management of the patient deteriorating pressure ulcer.
The facility's policy and procedure titled "Pressure Ulcer: Prevention, Assessment, and Management," last reviewed and revised April 2013 notes, "several aspects of pressure ulcer management are driven by physician or other members of the interdisciplinary team ... " The policy notes that nursing staff would consult with members of the interdisciplinary care team as needed for debridement of pressure ulcer of devitalized tissue; use of antimicrobials and systemic antibiotics as indicated ...
Consequently, the patient was discharged to a Skilled Nursing Facility on 8/6/14 with an unstagable sacral ulcer that had not been assessed by a physician to determine a treatment plan and the need for debridement of devitalized tissue.
At interview with Staff #1, Patient Care Services Manager, on 9/28/15 at 2:30 PM, she stated, the prevention and management of pressure ulcer is a team approach; however, the care of the patient with pressure ulcer is physician driven. She acknowledged there was no physician assessment and written order for the care of the patient's pressure ulcer.