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NOVANT HEALTH PRESBYTERIAN MEDICAL CENTER 200 HAWTHORNE LANE BOX 33549 CHARLOTTE, NC 28233 July 28, 2017
VIOLATION: PATIENT RIGHTS: GRIEVANCES Tag No: A0118
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of hospital policy, open medical record review, and complaint/grievance review, and staff interview, the facility staff failed to identify and investigate a grievance related to patient care for 1 of 2 patient complaints (#7).

The findings include:

Review of the hospital's policy and procedure "Complaints and Grievances from Patients", last review date of February 15, 2017, revealed ".V..B. Grievances: A grievance is a written or a verbal concern about: (1) the patient's clinial care that cannot be resolved at the time by team members present; (2) abuse or neglect....1. Who coordinates the grievance process: The Patient Partnership Program and (name of hospital) Patient Services teams coordinate the process with assistance from team members, risk managers, and others as necessary...."

Open medical record review on 07/25/2017 through 07/28/2017 of a physician's History and Physical revealed a 732 pound [AGE] year old male admitted on [DATE] for social issues, wounds and rash. Further review revealed no caregivers at night and has been bed bound for 15 years due to weight. Currently "complains of burning with urination and constipation ... Past medical history is significant for diabetes insulin dependent, Hypertension, and [DIAGNOSES REDACTED], sleep apnea, and morbid obesity."

Review of complaint for patient #7 dated 03/24/2017 revealed "Patient doesn't feel he is getting bathed frequently or thoroughly enough." Further review revealed "Patient reported that he wasn't being washed regularly or thoroughly enough, although he did say that he had been bathed the previous day. Patient reported that staff did not respond quickly enough to the call bell. Patient reported a foul "rotten" smell underneath one of his bandages and no one seemed to be addressing it." Further review of complaint in section labeled "What was done to resolve the issue to prevent it from becoming a grievance? (A grievance usually involves a quality of care issue that can't be handled by the person hearing the issue): Patient Partnership visited at patient's request patient partnership apologized for patient's experience patient partnership informed nursing staff of patient complaints and needs."

Interview on 07/27/2017 at 1335 with AS #1 revealed grievances and complaints are handled by the Patient Partnership Program. Further interview revealed all of the Patient #7's complaints and grievances were handled by the newest employees who were recently out of orientation. Further interview revealed the complaint should have been marked as a grievance. Furter interview revealed policy was not followed to complete a grievance and the investigation.
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on hospital policy reviews, medical record reviews, staff and physician interviews, the hospital nursing staff failed to assess wounds and follow physician's orders for wound care and consults for 1 of 2 sampled patients with wounds (#7).

The findings include:

1. Review of policy titled, "Skin Assessment and Management," with revision date of August 15, 2016, revealed " ...VI. Documentation: Size of wound in centimeters, location, presence of undermining, tunneling, presence of odor/drainage, color and type of tissue in wound bed, periwound skin assessment ..."

Open medical record review on 07/25/2017 through 07/28/2017 of a physician's History and Physical revealed a 732 pound [AGE] year old male admitted on [DATE] for social issues, wounds and rash. Further review revealed no caregivers at night and has been bed bound for 15 years due to weight. Currently "complains of burning with urination and constipation ... Past medical history is significant for diabetes insulin dependent, Hypertension, and [DIAGNOSES REDACTED], sleep apnea, and morbid obesity."

Review of nursing documentation for left chest wound on 01/30/2017 through 02/06/2017 revealed no documentation of wound measurements, wound bed condition, or periwound assessment during dressing changes. Review of nursing documentation for left chest wound for 06/01/2017 through 06/11/2017 revealed no documentation of wound measurements, wound bed condition, or periwound assessments during dressing changes. Review of nursing documentation for sacral wound for 07/16/2017 through 07/27/2017 revealed no documentation of wound measurements or periwound assessments.

Interview on 07/27/2017 at 0915 with wound care nurse #1 revealed staff nurses are trained to measure and document condition of wounds. Further interview revealed no documentation of these wounds during this time frame.

2. Review of policy titled, "Assessment/Reassessment Dimensions," with revision date of July 15, 2016, revealed " ...D. Patients will receive a full/complete assessment by an RN: 1. On admission. 2. At least daily and as warranted by the patient's clinical condition. ...E. Patients will receive a focused re-assessment: 1. At least every shift and as warranted by the patient's clinical condition. 2. At regular intervals per service specific standards. 3. When there is a change in primary caregiver. 4. To determine a patient's response to a care intervention ...."

Review of physician's orders written on 02/01/2017 at 1327 for wound care revealed "On 03/08/2017 at 1450, physician wrote "Cleanse all open wounds daily." On 04/06/2017 at 1932, "NS cleanser, Pack with Aquacel Silver/cover with foam dressing on Right Chest wall q (every) 24 hrs." Then on 04/27/2017 at 1428, frequency was changed to every 48 hours. On 05/20/2017 at 1616, same except delete silver and cover with polymen." Review of documentation of right chest wound for sampled months [partial June (dates 1-13) and partial July (dates 16-27) 2017] revealed no documentation of dressing changes on June 4, 5, 6 or 7th. Further review revealed no dressing changes on July 20 or 25th. Review of documentation of wound assessments of skin tears to abdomen for month of July 2017 revealed no documentation of assessment on July 17, 19-24. Review of documentation for wound assessments of scrotal areas revealed no assessments of wounds on July 19-27, 2017.

Interview on 07/28/2017 at 1215 with nurse educator revealed dressings were not done according to physician orders. Further interview revealed wound assessments were not done as per policy. "Can't tell if wound is getting better or worse. "

3. Review of Nursing Communication order authorized by attending physician on 02/15/2017 at 1328 revealed "Please ask wound care to have a look under his pannus (large growth below his abdomen). There is a developing open wound there."

Review of Wound consult notes revealed next wound consult evaluation dated 03/07/2017 (20 days after wound consult order).
Interview on 07/27/2017 at 0915 with wound care nurse revealed wound consults are done within 24-48 hours.

Further interview revealed consult was not performed as should have been.

NC 618