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 HEALTHCARE MEMPHIS HOSPITALS 1265 UNION AVE SUITE 700 MEMPHIS, TN 38104 Oct. 6, 2020
VIOLATION: NURSING CARE PLAN Tag No: A0396
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review and interview, the hospital failed to ensure the nursing care plan (POC) was implemented for 1 of 4 (Patient #4) sampled patients.

The findings included:

1. The hospital "NO ULCERS BUNDLE and Skin Care Policy" policy revealed, "...PURPOSE: Identify level of risk, assess skin integrity, develop and implement plan of care to maintain and/or improve skin status...Use moisture barrier products for each incontinence episode and as needed..."

2. Medical record review revealed Patient #4 was admitted to the Intensive Care Unit (ICU) on 5/9/19 with diagnoses which included [DIAGNOSES REDACTED] Sepsis, Anemia, [DIAGNOSES REDACTED], Diabetes, Acute Systolic Congestive Heart Failure, Acute Dyspnea, and Ureterolithiasis.

The Initial Skin assessment dated [DATE] at 11:30 AM, revealed Patient #4's skin was intact.

The (POC) included the use of a purwick external catheter, moisture barrier for incontinent episodes, repositioning every 2 hours, microclimate absorptive pad, and pillow.

On 5/12/19 at 8:00 PM, a preventive foam dressing was placed on Patient #4's sacrum due to redness.

Patient #4 was transferred to the Step-down unit on 5/13/19 at 2:57 PM.

The skin assessment dated [DATE] at 8:00 PM, revealed redness to Patient #4's groin and buttock. Interventions in place included purwick external catheter, repositioning, microclimate absorptive pad, barrier cream, and increasing mobility such as being up in the chair.

On 5/14/19 at 7:30 PM, the nurse documented moisture breakdown to buttocks and groin, sacrum red, but blanchable.

The GI (Gastrointestinal) OUTPUT Flowsheet documented episodes of incontinence on the following dates and times:
-5/14/19 at 7:30 AM
-5/15/19 at 7:30 AM
-5/15/19 at 8:00 PM
-5/16/19 at 8:00 PM
-5/16/19 at 11:14 PM
-5/17/19 at 1:00 AM

There was no documentation in the medical record barrier cream was applied after each of these incontinent episodes.

The Physician ordered a Wound Nurse Consult on 5/20/19.

The Wound Care Notes dated 5/21/19 at 8:46 AM, revealed "...diffuse area of incontinence-associated dermatitis to buttock and perineum...patient incontinent..."

2. In a telephone interview on 9/30/2020, the Administrative Director of Nursing, verified barrier cream should have been applied to Patient #4 after each incontinent episode and it should have been documented in the medical record.