HospitalInspections.org

Based on interview and record review, the facility failed to ensure that an RN supervised the care of one (1) of 5 sampled discharged patients (Patient ID # 6). The RN failed to ensure:

a. physician order for "compression hose " was implemented

b. daily skin assessments were completed per policy

Findings include:

TX # 00188375

Record review on 01-10-14 of the clinical record of Patient ID # 6 revealed she was an
82 year old female patient admitted to the facility on 09-20-13 for right lower extremity cellulitis with lymphedema, right buttock unstageable wound. A 2-D echo was ordered on admission as well as lower extremities Doppler studies (arterial and venous), EKG, and labs. Consults with Nutrition, Physical Therapy, Occupational Therapy, Would Care, and Nurse Educator were ordered.

Patient ID # 6:

Compression hose ordered; never applied:

Review of physician order dated, 10-03-13 (0845) read: " Compression hose to B/L
(bilateral) lower extremities at 20 mm Hg. " A handwritten note next to the order dated 10-09-13 read: " TED hose applied -done "

Record review of nurse ' s notes dated 10-08-13 (time 1900): " new order noted form dr
( ). Charge nurse & unit secretary to remind central supplies to order the machine. Hose available in hospital at present time... "

Further review of physician order, dated 10-10-13 (0645p): " Please follow-up on Compression hose. See 10-03-13 order. "

Interview on 01-23-14 at 3: 30 p.m. Interim Chief Nursing Officer (CNO) /ID # 2 , she was unable to locate any documentation in the record that the compression hose had been applied to Patient ID # 6 and nursing should have followed up on that order. She acknowledged that it was possible the nurse who applied TED Hose thought they were compression hose. The Interim CNO/ID # 2 said she would in-service the nursing staff on compression hose / SCD (sequential compression devices).

Skin Assessments Not completed:

Patient ID # 6

Review of Patient ID # 6 ' s admission diagnosis revealed she was admitted for lower extremity cellulitis and edema. Review of the nursing admission assessment on 09-20-13 day shift: " bilateral lower extremity edema + 4/; night shift was +3 edema "

Review of the " Nursing Daily Documentation " flow sheet revealed a section for skin assessments to be documented on the night shift and the day shifts.

Further review of the daily skin assessments revealed the following dates were blank or incomplete:

Day shifts: September /21, 22, 26, 27 and October 01, 02, 04

Night shifts: September /21, 25, 26, 27, 28 and October 01, 02, 04, and 05

Patient ID # 6 was discharged home with home health services on 10-15-13.

Interview on 01-23-14 at 3: 30 p.m. Interim CNO /ID # 2 at 3:30 p.m. she said the expectation was that nursing would conduct and document a complete patient skin assessment every shift. She acknowledged it was not possible to assess for improvement of Patient ID # 6's lower extremity edema because the skin assessments were incomplete.

Review of facility policy titled " Documentation of Patient Care, revised date 11/2011, read: " ... 2. Admission assessments and all reassessments required by the patient ' s condition are documented in the medical record. Reassessments are documented on the flow sheet every shift. "