Bay Vue Nursing and Rehabilitation Center of Bradenton, FL, was cited after a resident did not receive his antibiotic for 7 days following a procedure on his right, second toe. The lack of medication for the wound resulted in hospitalization.
The resident in this citation had four stitches on his toe due to a vascular ulcer. Vascular ulcers are chronic or long term skin ulcers, and this resident’s ulcer needed to be consistently monitored. The toe needed to be cared for by the facility upon his return from the wound care facility. If there were any changes in the resident’s condition, it was to be closely documented. The resident’s care plan reflected that the facility needed to be on the lookout for signs and symptoms of infection in the toe, including redness and swelling. To ward off infection, the resident was also supposed to take antibiotics.
The investigator reviewed several nursing notes to identify when a change in the resident’s condition occurred. One note revealed that while a nurse was changing the resident’s dressing, the toe was slightly discolored and warmer than the other toes. It had a purplish color and appeared swollen. The nurse applied a new dressing and elevated the resident’s foot, intending to monitor the toe throughout the day. Her note did not indicate there was any sign of infection, even though the wound care center said to look out for and document signs of swelling. The investigator reviewed another wound care note, which stated the resident was to receive an antibiotic four times a day for ten days. The resident had not received any antibiotic for seven days.
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The facility’s policy for documenting the medical condition of residents states, “each resident’s medical record shall contain an accurate representation of the actual experiences of the resident and include enough information to provide a picture of the resident’s progress through complete, accurate, and timely documentation.” The purpose of the policy is to ensure the facility quickly acts upon any change in condition, particularly one that negatively affects the health of a resident. In this case, a nurse did not document the resident’s change of condition or pass this information onto the unit manager so that proper action could be taken for the resident’s recovery.
After reviewing the medication administration sheets, the unit manager confirmed that the antibiotic should have been ordered; she also said the physician should’ve been notified when the facility confirmed the resident wasn’t receiving the prescribed medication. Because of this, the resident was sent back to the wound care center where a wound care nurse confirmed the infection with a bone biopsy. The wound care nurse called the facility to alert of the staff; it was then that she learned the facility never ordered the medication. At this point, the resident’s toe was “blown up, angry, red and significantly inflamed.” Because the toe was in such bad shape, the resident was sent to the emergency room and was there for at least six days.
An interview with the Director of Nursing (DON) confirmed the facility did not contact the wound center to let them know the resident didn’t receive his antibiotic for seven days. The DON confirmed that when a resident goes out to a wound care center and comes back, the unit manager, nurse manager, and nurse on duty should look at any new information from the wound care center and call the facility physician with any updates. If there is any change in the resident’s condition while under the care of the facility, they are to contact the wound care center.
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The investigator of this citation interviewed the Advanced Registered Nurse Practitioner (ARNP). He stated he wasn’t made aware of the changes to the resident’s wound. He confirmed that the change in the resident’s condition should have alerted the facility to contact the physician and document the change. The ARNP stated that “unit managers get so busy with reports and meetings that they don’t have time to assure the charts are correct.” He stated he wanted to make sure the residents received consistent, reliable care, but he doesn’t “dig through the notes with each visit.”
When residents are placed into the care of a nursing home, they put their well-being in the hands of other people. Nursing home staff are often overwhelmed by the amount of patients they need to take care of. However, families rely on nursing home staff to care for their loved ones and advocate for their needs. The resident in this citation needed an antibiotic to avoid infection. Instead, the medication was never ordered and his change of condition was not properly documented. This put the resident’s health and overall quality of life at risk.
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During this difficult time of quarantine, self-isolation, and social distancing throughout Florida and the nation, we want you to know that there are ways to check on any loved ones in a nursing home facility. While you likely won’t be able to visit in person, below are a few tips for checking on your loved one to make sure they are getting the care they need.
- Call every day. Set a time to catch up with your loved one, even if it’s just a five minute call. If your loved one is tech-savvy and uses FaceTime, check in that way! Just one call can help ensure your loved one is still getting the care you expect from the nursing home.
- Call after each shift. Find out when each shift starts and ends, and talk to the nurses after each shift to check on the consistency and quality of your loved one’s care.
- Find out what you can or can’t do. During this time, most nursing homes won’t permit you to enter the nursing home facility in order to protect you and your loved ones. Some, however, let families enter when the loved one is on hospice. Be sure to clarify the rules with the facility so you can plan for any situation.