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ENCOMPASS HEALTH REHABILITATION HOSP OF THE WOODLA
RN SUPERVISION OF NURSING CARE
Tag No.: A0395
Based on interview, review of hospital policy and procedure, and review of one of two clinical records as part of a complaint investigation, the charge RN failed to supervise patient care by failing to ensure compliance with physical therapy protocol.
Findings include:
1. Citing patient #1, an 82 year old female, admitted to the facility on 8/2/2010. Review of the history and physical (H/P) reflected the patient had end-stage degenerative joint disease of the left knee and difficulty walking. Knee X-ray showed severe bone- on bone changes. The patient underwent a left total knee replacement on 7/28/2010.
Plan:
. daily physical therapy for range of motion(ROM) and quad strengthening.
. foam block 3 times per day
. use CPM 0 - 90 degrees
Review of nursing progress notes by LVN #54 at 1900 hrs on 8/4/2010
"Left knee remains reddened and hot to touch. Ice pak applied. Extremity elevated and CPM used frequently."
Review of physical therapy notes 8/5/2010 from 8:00am -9:00am
"Patient complained of increased pain on scale 10/10 due to CPM being left on for 8 hours. Hold CPM."
8/6/2010 "Hold off on CPM."
8/7/2010 "Per doctor hold off on CPM."
8/9/2010 " CPM applied left knee at 0 - 40 degrees."
Review of hospital policy titled: "Continuos Passive Motion (CPM) Application"
A. Indications:
Any condition with limited range of motion of knee, i.e., total knee replacement.
B. Contraindications:
1. Significantly increased swelling, temperature or redness of the knee.
2. Tenderness of thigh/calf of involved leg
.C. Duration: 6 - 8 hours per day (intermittent)
2. Review of Patient Complaint Form dated 8/5/2010 from Patient #1:
" Patient stated that on the night of 8/4/2010 the night nurse ordered the CPM to be on her knee for 8 hours (continuos). The tech told the nurse the patient had the CPM on already today but the nurse said "It doesn't matter. it needs to be on for 8 hours. Her rehab is being affected due to this incident."
3. Chief Nursing officer stated on 9/13/2010 that she disciplined LVN #54 on 8/6/2010 for leaving the CPM on all night even after the patient asked for it to be taken off. She was reminded that CPM must not be on all night but just 2 hours on and 2 hours off while awake.