| 19 |
GUAM MEMORIAL HOSPITAL AUTHORITY |
655000 |
499 NORTH SABANA DRIVE |
BARRIGADA |
GU |
96913 |
2017-08-24 |
279 |
E |
0 |
1 |
10C511 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop a comprehensive plan of care that was individualized for each resident to meet the resident's medical, nursing, mental and psychosocial needs identified nor did the facility update the care plan when there was a change in the resident's condition for 3 Residents (R)2, R3, R7) of 8 sampled residents. Findings include: 1. Review of the medical record for Resident (R) 3, revealed that the resident was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. Review of the R3's care plan dated 11/10/17, with Staff Member 18 on 8/22/17 at 2:00 p.m., revealed that the facility uses the Nursing [DIAGNOSES REDACTED]. a. R3 had a care plan for constipation. Comments stated Patient is having [MEDICAL CONDITION]. The Problem statement read; Constipation: related to abdominal muscle weakness; habitual denial; habitual ignoring of urge to defecate; inadequate toileting; irregular defection habits; insufficient physical activity; recent environmental changes; depression, emotional stress, mental confusion, nonsteroidal anti-[MEDICAL CONDITION] drugs (NASAIDs), opioids, phenothiazine's, and sedatives, neurological impairment, electrolyte imbalance, hemorrhoids, Hirschsprungs's disease (a dis condition that affects the large intestine (colon) and causes problems with passing stool). pregnancy, prostate enlargement . The care plan failed to be individualized. The long-term outcome was that the Patient will maintain passage of soft formed stool every 1 to 3 days without straining; state relief from discomfort of constipation and identify measures that prevent or treat constipation. Intervention 1: included to assess usual pattern of defecation, history of bowel habits or laxative use; diet, obstetrical/gynecological history, alterations in perianal sensation. Intervention 6: included to encourage patients to resume walking and activities of daily living as soon as possible if their mobility has been restricted. Intervention 7: included to ask patients when they normally have a bowel movement and assist them to the bathroom at that same time every day to establish regular elimination. Intervention 9: included to help patients onto a bedside commode or toilet so they can either squat or lean forward while sitting. Although it had been noted in the comments section that R3 had a [MEDICAL CONDITION], there was nothing in the problem statement or in the interventions that spoke to the care of the resident's [MEDICAL CONDITION] or [MEDICAL CONDITION] care. b. R3 was admitted to the facility with an indwelling Foley catheter (a Foley catheter is a urinary catheter that collect urine from the bladder). The Foley catheter was replaced with a supra pubic catheter (suprapubic catheter is a surgically created connection between the urinary bladder and the skin which is used to drain urine from the bladder) on 7/13/17. The resident's care plan was not updated to show the change in the type of catheter that the resident had or any changes to the care the resident would have with the supra pubic catheter. 2. R7, was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. The resident went to an offsite [MEDICAL TREATMENT] facility 3 days a week for treatment. Review of R7's care plan revealed a problem statement of on-going outpatient HD ([MEDICAL TREATMENT]). The expected outcome/goal was that the resident will retain her established outpatient HD treatment as follows: Tuesday, Thursday, and Saturday, with transport via hospital transport while admitted . Intervention noted that the social worker will maintain follow-up with resident/family and providers to ensure continuity of treatment and assist coordinate necessary changes during admission. The care plan did not include any interventions for monitoring the resident's vascular access (vascular access, is a way to reach the blood for [MEDICAL TREATMENT]. The access allows blood to travel through soft tubes to the [MEDICAL TREATMENT] machine where it is cleaned as it passes through a special filter, called a dialyzer) for bleeding, signs of infection, not using the access arm for blood pressures, keeping the area clean, or checking the thrill in the access every day (the thrill is the rhythmic vibration a person can feel over the vascular access). During the review of these care plans 8/22/17 at 2:00 p.m. with Staff Member 18, the staff member confirmed that the care plans for both R3 and R7 were not individualized to meet the residents' needs. |
2020-09-01 |