| 73 |
GUAM MEMORIAL HOSPITAL AUTHORITY |
655000 |
499 NORTH SABANA DRIVE |
BARRIGADA |
GU |
96913 |
2012-01-26 |
279 |
D |
0 |
1 |
J2NN11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility did not develop a comprehensive care plan for each resident that included measurable objectives and timetables to meet the resident's medical, nursing, and mental and psychosocial needs that were identified in the assessment. Findings include: 1. Resident 2 was admitted on [DATE] with several [DIAGNOSES REDACTED]. Review of the Mini Nutritional Assessment dated 1/07/12, revealed that Resident 2 was nutritionally at high risk and with increased nutrient needs related to severe malnutrition (as evidenced by) severe protein depletion with [MEDICATION NAME], and cachexia . The assessment also noted that his height was 5 feet and 5.75 inches and that he weighed 96 lbs. Initial nutritional recommendations dated 1/07/12 included providing Resident 2 with enteral feedings of [MEDICATION NAME] 1 can every 6 hours for 24 hours increasing to 1 can every 4 hours, and 150 ccs water for flush. This regimen, accordingly, would provide the resident with 1500 kcal and 61 gms of protein per day. The recommendation further noted monitoring of tube feeding residuals, monthly weights, weekly laboratory tests, and hydration status. Further review of the medical record revealed that while a care plan was written for special needs--providing nutritional support, the plan however was developed relative to the risk for aspiration and not the resident's need for nutritional support. The care plan, for example, did not identify goals that needed to be met or indicators that needed to be monitored to help ensure that Resident 2 met established nutritional benchmarks such as weight and [MEDICATION NAME] levels. Further review of the care plan revealed the lack of identification of a desired or target weight and did not specify if the current enteral feeding regimen allowed for weight gain. While the resident was described in a dietary note dated 1/16/12 as being underweight (weight noted on admission was 96 lbs), no other weight measurements were obtained until 1/25/12 when a weight of 95.2 was recorded. Further review of the medical record revealed that an [MEDICATION NAME] level (a measure of protein stores; normal limit 3.5 - 5 gm/dl) of 2.2 was obtained at the acute care hospital on [DATE]. Review of Resident 2's medical record at the facility however revealed that while laboratory tests including chemistry panels were available, there was no indication that an [MEDICATION NAME] level however was obtained as a measure of outcome to help determine if current interventions were effective or needed to be adjusted. 2. Resident 1 was admitted to the facility on [DATE] with several [DIAGNOSES REDACTED]. Review of the minimum data set ((MDS) dated [DATE] revealed that the resident was alert and oriented, dependent on staff for most activities of daily living, and continent of bladder function. The care area assessment (CAA) summary for the current admission noted that urinary incontinence will not be care planned because the resident is continent. Review of nurses notes including on 1/16/12 revealed that Resident 2 was incontinent of bladder. On 1/18/12, for example, the resident was documented as incontinent of bladder and bowel. 1/20/12, the resident was also noted as being incontinent of urine. In addition, SNU (skilled nursing unit) nurse aide flowsheets dated 1/20/12 through 1/23/12 described Resident 2 as incontinent of bladder function. In spite of the documentation of incontinence, review of the medical record revealed the lack of indication that a care plan was developed to address the change in bladder status which included goals and outcomes as well as interventions to prevent further diminishment of function. During an interview on 1/24/11, Resident 2 stated that while he had been having episodes of urinary incontinence which required him to wear briefs, that he however still feels the urge if he has to urinate. The resident added that he had been having accidents because of the increasing urgency and the delay and difficulty of getting him to the bathroom. 3. There was no evidence that the interdisciplinary team developed a comprehensive care plan to address the individual needs of a [MEDICAL TREATMENT] resident. For example: Resident 8 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 1/24/12 at 3:30 p.m., Resident 8's husband expressed concern regarding the coordination of [MEDICAL TREATMENT] treatments related to schedules and transportation. He indicated that post surgery, Resident 8 was moved to the Tuesday, Thursday, Saturday last shift schedule due unavailability of the M-W-F slot. The [MEDICAL TREATMENT] facility would call them if ever there was an available chair to dialyze earlier than scheduled. However, at times, the [MEDICAL TREATMENT] schedule would change and they remain waiting for hours on standby until the first available chair would be available. This also affects arrangements with transportation services. Interview with the social service designee on 1/25/12 at 10:30 a.m. revealed that they discussed these issues with the husband. review of the resident's medical record revealed [REDACTED]. |
2017-01-01 |