| 44 |
BOYINGTON HEALTH AND REHABILITATION |
255092 |
1530 BROAD AVE |
GULFPORT |
MS |
39501 |
2017-01-13 |
281 |
D |
0 |
1 |
QXQE11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, record review, review of the facility's CNA (Certified Nursing Assistant) Scope of Practice/Orientation, Perry Potter Nursing Skills and Procedures Eighth Edition, Mississippi Board of Nursing Rules and Regulations, and facility policy review, the facility failed to follow professional standards of care related to the failure to check Resident #18's Percutaneous Endoscopic Gastrostomy (PEG) tube placement prior to medication administration for one (1) of two (2) PEG tubes observed during med (medication) pass, and failed to ensure licensed nursing staff applied Resident #13's medicated cream after completion of incontinent care for one (1) of five (5) incontinent care observations. Findings include: A review of the Mississippi Board Of Nursing Rules and Regulations in Chapter 3 section 1.3, revealed: medication administration may only be delegated to another registered nurse or licensed practical nurse and not to an unlicensed person. This would include medicated ointments, lotions and protective barriers, regardless of skin integrity. A review of the Perry Potter Nursing Skills and Procedures, eighth Edition, under the topic Topical Skin applications, revealed: The skill of administering topical medications cannot be delegated to nursing assistive personnel. Review of the facility's policy titled, Administering Medications Through An Enteral Tube, dated (MONTH) (YEAR), revealed the purpose of this procedure is to provide guidelines for the safe administration of medications through an Enteral tube. This policy revealed to check placement of the Nasogastric, Esophagostomy, or Gastrostomy Tube, auscultate the abdomen (approximately three inches (3) below the sternum) while injecting ten (10) milliliters (ml) of air into the tube, and listen for the whooshing sound in the stomach then gently pull back and aspirate stomach contents. Review of the facilities document titled, CNA Scope of Practice/Orientation, dated 07/16/13, revealed listed under the column labeled DONT the following instructions: Do not apply any topical ointments or creams that are medicated whether prescription or over the counter. Resident #18 An observation during medication administration on 1/13/17 at 11:12 AM, revealed Licensed Practical Nurse (LPN) #5 prepared to administer [MEDICATION NAME] 20 milligrams (mgs) and [MEDICATION NAME] 10 mgs. via Resident #18's PEG tube. LPN #5 proceeded to check the PEG tube placement, and pushed 10 millimeters (ml)s of water instead of air into the PEG Tube, and auscultated (listened for the whoosh sound) with a stethoscope below the Xyphoid Process (lower part of the sternum). In an interview on 1/13/17 at 11:30 AM, LPN #5 confirmed she used water instead of air to check placement of Resident #18's PEG tube. LPN #5 stated, I was nervous. Record review of the Face Sheet revealed the facility admitted Resident #18 on 4/3/12 with the included [DIAGNOSES REDACTED]. Review of Resident #18's Quarterly Minimum Data Set (MDS) with the Assessment Reference Date (ARD) of (MONTH) 17, (YEAR), revealed the Brief Interview for Mental Status (BIMS) score was not completed due the resident was not able to complete the interview. Resident #18's Cognitive Skills for Daily Decision Making was coded a three (3), which indicated severe impairment, and rarely or never made decisions. Resident #13 Observation on 01/12/17 at 11:00 AM, revealed Resident #13 was provided incontinent care by Certified Nurse Aides (CNAs) #2 and #4. CNA #2 applied a cream to the rash on Resident #13's buttocks and perineal area after completing the incontinent care. Observation at this time of a package of the cream revealed it was Z-Guard, and Zinc Oxide 17% (percent) was listed as an active ingredient. Interview with CNA #2 on 01/12/17 at 3:00 PM, revealed she confirmed she applied the Z-Guard cream to the resident following the incontinent care. She further stated, Z-Guard cream was given to the CNAs by the nurses for all incontinent care, and from what they told us it was not a medicine. Interview with CNA #4 on 01/13/17 at 10:00 AM, revealed they were using Z-Guard as a barrier cream after incontinent care. CNA #4 stated, they told us today we could not use it because it has medicine in it, and we were told to take it all off the floor. Interview with Registered Nurse (RN) #1 on 01/13/17 at 10:15 AM, revealed she stated, Z-Guard is our house stocked barrier cream. Review of facility's document titled, CNA Visual /Bedside Kardex Report, for Resident #13 revealed instructions to use Z-Guard Barrier Cream with incontinent care. Review of Resident #13's Care Plan revealed an intervention to apply Z-Guard cream with incontinent care. Review of the facility's Face Sheet revealed the facility admitted the resident on 06/14/07. Resident #13's [DIAGNOSES REDACTED]. Review of Resident #13's MDS with an ARD of 12/14/16, revealed a Brief Interview of Mental Status (BIMS) score 14, indicating the resident was cognitively intact. Further review of the MDS revealed Resident #13 required extensive assistance with one to two (1 to 2) person physical assist with bed mobility, transfers, toilet use, dressing, and bathing. Resident #13 was always incontinent of bowel and bladder. |
2020-09-01 |