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.

METHODIST DALLAS MEDICAL CENTER 1441 NORTH BECKLEY AVENUE DALLAS, TX 75203 Aug. 10, 2020
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on interview and record review, the facility's registered nurses failed to supervise and evaluate the nursing care for patients that were hospitalized from [DATE] to 07/30/2020, in that:

A. There was no documentation by nursing staff that the plan of treatment for using foam, and/or Aquacel AG, and/or Iodosorb was completed as recommended by the wound care nurse (WCN), citing 5 of 5 patients (Patient #1, Patient #2, Patient #8, Patient #9, and Patient #10).

B. There was no consistent documentation that patients were turned and repositioned every 2 hours as required, citing 3 of 5 patients (Patient #2, Patient #8, and Patient #10).

Findings:

A. 1. Patient #1 was admitted to a medical-surgical floor on 02/22/2020 for [DIAGNOSES REDACTED] with unknown etiology. On 04/08/2020 a wound consultation was conducted by a WCN. The consultation note reflected "Consulted for bilateral elbows...Recommended treatment Iodosorb and foam daily and PRN (as needed) when soiled or dislodged."

2. Patient #2 was admitted on [DATE] for Covid-19 infection. Per physician order an initial wound care consult was conducted on 06/23/2020. The WCN noted "Consult...ordered...Reason...Nose..." For nose, WCN recommended protecting the area with foam. Change every 3 days and PRN for soiling/dislodgment.

On 06/24/2020 WCN conducted an initial assessment of the right and left ear lobe. WCN recommended foam every three days or PRN for soiling or dislodgment.

On 06/25/2020 WCN assessed the Left great toe through 3rd and 4th toes, stage I. WCN recommended foam to pressure injuries every 3 days or PRN for soiling or dislodgment.

On 07/09/2020 a follow-up visit was conducted by the WCN. The WCN noted there were pressure ulcers to the left and right ears. WCN recommended foam every 3 days or PRN for soiling and dislodgment.

3. Patient #8 was admitted on [DATE] for Covid-19 infection. On 06/26/2020 a consultation of the left cheek was conducted by a WCN. The WCN noted "unable to fully assess the left cheek and will continue placing foam every 3 days and PRN for soiling or dislodgment."

4. Patient #9 was admitted on [DATE] for gunshot wound in the abdomen. Per physician's order dated 07/20/2020 a wound consultation was conducted for the trach collar site. WCN recommended Aquacel AG daily and PRN soiling/dislodgment.

5. Patient #10 was admitted on [DATE] for acute respiratory failure secondary to Covid-19. Per physician's order, a wound care consultation was conducted on 07/27/2020. The WCN noted the patient's right knee had a dark area and was unable to determine if it was a pressure injury. The WCN recommended foam every 3 days or PRN soiling/dislodging.

During an interview on 08/10/2020 at 2:00 PM in the conference room, Personnel #11 confirmed that there was no documentation by nursing staff that they were doing wound care treatments.

B. Patient #2 was admitted on [DATE] for Covid-19 infection. He was intubated on 06/16/2020. On 06/16/2020 at 07:01 the patient was in supine position. The next documentation for repositioning was at 19:01 (12 hours later). The next documentation for repositioning was on 06/17/2020 at 01:00 the patient was in prone position until 07:00 (6 hours). The next documentation for repositioning was at 17:00 (10 hours later). 06/21/2020 the patient was turned to his right side at 07:01. The next documentation for turning/repositioning the patient was at 19:19 (12 hours and 18 minutes later) indicating "Lying left side; Semi-Fowler's; Pillow support." On 06/22/2020 at 19:01 the patient was repositioned for pain comfort. The next documentation for repositioning the patient was on 06/23/2020 at 01:01 (5 hours later).

2. Patient #8 was admitted on [DATE] for Covid-19 infection. She was intubated on 06/12/2020. On 06/13/2020 from 03:00 to 07:01 (4 hours) the patient was "Lying left side, prone." On 06/14/2020 23:00 to 06/15/2020 15:00 the patient was in prone position for 16 hours. On 06/16/2020 from 19:00 to 23:00 the patient was in prone position for 4 hours. On 06/18/2020 the patient was not turned/repositioned from 05:00-08:00 (3 hours). On 06/21/2020 the patient was lying left side from 11:05 to 15:00 (3 hours and 55 minutes). On 06/22/2020 the patient was lying left side from 05:01 to 23:00 (17 hours and 59 minutes).

3. Patient #10 was admitted on [DATE] for acute respiratory failure secondary to Covid-19. He was intubated on 07/15/2020 at 07:30. On 07/16/2020 at 05:00 the patient was placed in a prone position. The next documentation that the patient was repositioned was at 11:00 (6 hours). On 07/17/2020 the patient was repositioned at 15:00. From 17:20 to 23:00 the patient was in a prone position (5 hours and 40 minutes). The documentation did not indicate the direction of the head. On 07/18/2020 the patient was in a prone position from 01:00 to 07:01 (5 hours and 59 minutes). At 09:12 AM the reposition item in the flowsheet was not filled out.

During an interview on 08/12/2020 at 12:08 PM via phone call, Personnel #6 stated initially the nursing staff were not consistent in turning patients. Now we have turn-teams that consistently turn patients every 2 hours.

In an interview on 08/20/2020 at 12:34 PM via email Personnel #3 was asked if they had identified inconsistent documentation regarding the turning and repositioning of patients every 2 hours as required. Personnel #3 replied that they did. "We have identified there are gaps and work that can be completed on those gaps. We have a report that can be run in EPIC that can track patient turn documentation and percentages. We can begin audits on those reports."