| 32 |
EASTVIEW REHABILITATION & HEALTHCARE CENTER |
15014 |
7755 FOURTH AVENUE SOUTH |
BIRMINGHAM |
AL |
35206 |
2018-01-25 |
684 |
D |
0 |
1 |
I9JH11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, resident record review, review of a facility policy titled Monthly Physician's Orders and review of a facility policy titled Pressure Ulcers the facility failed to ensure licensed staff provided as needed (PRN) Medication as ordered for constipation for Resident Identifier (RI) #77 and further failed to ensure RI #32 was turned and repositioned every two hours as care planned. These deficient practices affected two of 18 residents sampled. Findings include: 1. Review of the facility policy titled Monthly Physician's Orders with an effective date of 2/1/2004 revealed the following: . PURPOSE: To provide a documented review of the medical plan of care for each resident on a monthly basis by the physician. Resident #77 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of RI #77's Admission MDS (Minimum Data Set) assessment with an Assessment Reference Date of 12/26/17 revealed a BIMS (Brief Interview for Mental Status) score of 13 which indicated intact cognition. On 01/24/18 at 04:13 PM RI #77 told the surveyor about having to take stool softeners at times because of constipation. RI #77 said, I ask for them about every three days. On 01/25/18 at 05:26 PM RI #77 told the surveyor about having gone three, maybe four consecutive days without having a bowel movement (BM). RI #77 said, About one time a week they have to pull it (BM) out. RI #77's (MONTH) (YEAR) Physicians orders documented: . Order Date . 12/19/17 . [MEDICATION NAME] SODIUM 100 MG (milligram) SOFTGEL- GIVE ONE SOFTGEL BY MOUTH DAILY AS NEEDED FOR CONSTIPATION . 12/19/17 POLYETHYLENE [MEDICATION NAME] 3350 POWD- (powder) GIVE 17GM (gram) BY MOUTH DAILY AS NEEDED FOR CONSTIPATION . Review of RI #77's (MONTH) (YEAR) Bowel Report and DAILY BM (Bowel Movement) MONITORING SHEET revealed four consecutive days Resident #77 did not have a Bowel Movement, 1/12/18, 1/13/18, 1/14/18, and 1/15/18. Review of RI #77's (MONTH) (YEAR) Medication Administration Record [REDACTED]. On 01/25/18 at 5:55 PM, Employee identifier (EI) #4, Certified Nursing Assistant (CNA) said she took care of the resident about three days a week on first shift. When asked about RI #77's bowel patterns, EI #4 said, RI #77 did not really have BMs on the first shift. EI #4 was asked how often RI #77 was constipated. EI #4 was not sure but said, RI #77 might have BMs on another shift. On 01/25/18 at 6:25 PM, EI #5, CNA said, she always took care of RI #77 when she worked on the second shift. When asked what RI #77's bowel patterns were, EI #5 said, RI #77 did not really have a BM and sometimes nurses had to give a stool softener. EI #5 said, RI #77 would sometimes ask the staff to dig the BM out because it was stuck in RI #77's bottom. On 01/26/18 at 9:45 AM, EI #3, Registered Nurse (RN) was asked how many days had RI #77 gone without having a BM. EI #3 said, she was not sure, but the resident would be treated with standing orders or with a laxative already in place, if they did not have a BM in three days. When asked how often RI #77 had to be cleaned out (have BM manually removed), EI #3 said, maybe once or twice. On 01/26/18 at 11:30 AM, EI #1, Director of Nursing (DON) was asked how she would know when residents were not having regular BMs. EI #1 said, the facility had a system in their computerized charting called the BM report and it reported residents who had not had a BM for three days. EI #1 was asked to review both the Bowel Report and the BM Monitoring Sheets and was asked how many days Resident #77 had gone without a BM. After reviewing the reports EI #1 said, four days (1/12, 1/13, 1/14, and 1/15). When asked what she would expect staff to do if RI #77 was requesting BM to be pulled out and had BM stuck inside the rectum, EI #1 said, call the Doctor, treat, and assess. 2. A review of a facility policy titled Pressure Ulcers with a revised date of 11/2011 documented: . STANDARD: Pressure Ulcers are defined as ulcerations and/or necrosis of tissues overlying a bony prominence that has been subjected to pressure . PRESSURE ULCER PREVENTION . Assist the resident to change position . every two hours . Resident Identifier (RI) #32 was readmitted to the facility on [DATE] with [DIAGNOSES REDACTED]. A review of RI #32's annual Minimum Data Set (MDS) with an Assessment Reference Date of 01/01/2018 revealed RI #32's Brief Interview for Mental Status (BIMS) score of 15, indicating cognition intact. Section G of the MDS, for Functional Status documented RI #32 was totally dependent on staff for all activities of daily living (ADL). Section M documented RI #32 was at risk of developing pressure ulcers. On 01/24/2018 at 10:01 AM, RI #32 was observed lying in supine position. On 01/24/18 at 12:30 PM, RI #32 was observed lying in supine position. On 01/24/2018 at 03:00 PM, RI #32 was observed lying in supine position. On 01/25/18 at 03:00 PM, an interview with Employee Identifier (EI) #3, Registered Nurse (RN) Unit Manager. EI #3 was asked did RI #32 have any pressure ulcers. EI #32 said, no. EI #3 was asked if RI #32 was at risk for developing pressure ulcers. EI #32 said, yes. EI #3 was asked how often was RI #32 to be turned. EI #3 said, every two hours because RI #32 is at risk for developing pressure ulcers. EI #3 was asked who was responsible to ensure RI #32 was turned. EI #3 said, the Certified Nursing Assistants (CNA) and the nurses. EI #3 was asked if RI #32 could turn or reposition his/her self. EI #3 said, no. EI #3 was asked what was the potential harm in not turning RI #32 every two hours. EI #3 said, potential for developing pressure ulcers. |
2020-09-01 |