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Based on review of records and interviews with staff, the facility failed to ensure that nursing staff was trained to evaluate the nursing care for 1 of 4 applicable patients whose records were reviewed. Patient #1 required specialty compression bandaging to treat lymphedema; these bandages became loose and soiled, and nursing staff was not trained to re-bandage the patient while the certified lymphedema therapist was unavailable for 2 ? days.

Findings were:

Review of the medical record for Patient #1 revealed that the patient has chronic lymphedema, caused by the blockage of the lymph vessels that drain fluid from tissues throughout the body. The patient had wounds on the lower extremities that required IV antibiotics, wound care, and lymphedema therapy ordered Monday - Friday during the hospital stay for the chronic condition.
An in-person interview was conducted the morning of 5/12/14 with Staff #2, Certified Lymphedema Therapist. Staff #2 is the only certified therapist at the hospital and works weekdays, Monday through Friday. The therapist explained that lymphedema therapy involves manual lymph drainage, applying compression, and performing skin care. Staff #2 explained that patient #1 had lymphedema therapy on Friday 1/31/14, and compression bandages were applied. Because of the large amount of lymph drainage, the patient's bandages became loose and soiled, and nursing staff removed the dressings and threw them away. They applied ACE bandages at that time. When questioned about whether nursing staff can apply dressings for lymphedema patients, Staff #2 stated "only I can reapply the dressings." The therapist returned the next Monday, checked on the patient and found the ACE bandages had been applied. Staff #2 then issued the patient a tensoshape bandage, (pre-shaped elasticized tubular bandage suitable for light to medium support), which is the preferable type of bandage rather than ACE wrap, and can be applied by nursing staff. The therapist stated that the nursing staff had not been trained how to apply the tensoshape bandage which should be applied if the original bandages are removed when the therapist is not at the hospital.

A Patient Complaint Form was prepared on 2/6/14 which documented Patient #1's complaint about the compression dressing removal the previous weekend, and the application of ACE wraps by the nursing staff. This form was reviewed by the department head, and corrective action proposed was to ensure that nursing staff receive an inservice about lymphedema.

In an in-person interview conducted the afternoon of 5/12/14, the Interim Chief Nursing Officer, Staff #1, stated that there was no record of an inservice about lymphedema provided to the nursing staff.