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.

LAFOLLETTE MEDICAL CENTER 923 EAST CENTRAL AVENUE LA FOLLETTE, TN 37766 Sept. 17, 2018
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility policy, medical record review, and interviews, the facility failed to ensure a wound care consult was completed timely for 1 Patient (#1) of 5 patients reviewed.

The findings included:

Review of facility policy "Assessment, Initial, and Reassessment" revised 4/11/16 revealed "...a Registered Nurse [RN] will assess the patient's needs for nursing care in all setting in which nursing care is provided...the RN will collaborate with other members of the nursing team to identify the patient's health care needs and formulate nursing diagnoses and a plan of care...whenever necessary and appropriate other disciplines must be consulted in formulating the patient's care..."

Medical record review revealed Patient #1 was admitted to the Senior Behavioral Unit (SBU) on 8/21/18 with diagnoses including Neurocognitive Disorder of Alzheimer's Type with Behavioral Disturbance, Depression, Urinary Tract Infection (UTI), and a History of Falls. Continued review revealed the patient was discharged back to the skilled nursing facility on 9/5/18.

Medical record review of an Admission Nursing Skin assessment dated [DATE] at 11:30 PM revealed the patient had a reddened area to the buttocks with no drainage noted.

Medical record review of a Wound Care Consult dated 8/27/18, not timed, revealed a wound care consult was faxed to the wound care team by the unit nurse with a description of "...type: pressure...reddened area with stage 1 [unopened sore] area on buttocks..."

Medical record review of a Wound Care Consult dated 8/29/18 at 9:45 AM revealed "...called [named nurse] at wound care. Could not tell me when the patient would be seen. They did receive fax [consult]..."

Medical record review of a Wound Care Flow Sheet dated 8/30/18, not timed, revealed Patient #1's wound was assessed by the wound care nurse. Further review revealed "...appearance: coccyx inner buttock 0.9 x [by] 0.6 x 0.1 cm [centimeter], stage 3 [sore extends to the tissue below creating a crater] shallow...cleanse wound with wound cleanser/bath...apply [named ointment] bid [twice daily] and PRN [as needed]..."

Interview with RN #1 on 9/12/18 at 3:40 PM, in the conference room, revealed the nursing staff noticed a reddened area with skin breakdown on the patient's buttocks on 8/27/18 and faxed the information to the wound care team on 8/27/18. Continued interview revealed the patient was incontinent of urine and bowel and required total assistance. Further interview revealed "...on 8/29/18 the patient had not been assessed by wound care so I called and talked to [named wound care nurse] and she could not tell me when wound care would be able to see the patient but she said they had received the fax...the wound care nurse saw the patient on 8/30/17 [3 days after the wound care consult was ordered]..."

Telephone interview with the Wound Care Nurse on 9/12/18 at 4:10 PM revealed the wound care nurse assessed the patient's wound on 8/30/18 (3 days after the wound care consult was ordered).

Interview with the unit Nurse Manager on 9/12/18 at 4:45 PM, in the conference room, confirmed "...the patient did have a skin issue...there was a delay in wound care seeing the patient..."