IDPH has cited and fined Parker Nursing & Rehabilitation Center in Streator regarding the pressure ulcers or bed sores one resident developed while a resident there.
There are two basic federal regulations relating to bed sores. The first of these provide that a resident entering a nursing home without a bed sore should receive care to prevent pressure ulcers and should not develop them unless the resident’s clinical condition demonstrates that they were unavoidable. The second of these provides that in essence that after a resident develops a bed sore, they should receive care, treatment, and services necessary to promote healing, prevent infection, and prevent the development of new bed sores. This is a reason that bed sores are a focal point of emphasis in the assessment (including the use of the Braden scale) and care planning process.
It appears from this citation that the staff at Parker failed on both counts.
The resident at issue had developed bed sores on his gluteal folds and on his coccyx. There were orders in place for use of a duoderm, a type of dressing which is intended to prevent contamination of the wound. When the IDPH surveyor was doing her inspection, the dressing which had been ordered were not on the resident. This amounts to a violation of the regulations which require the nursing home to provide the necessary care, treatment, and services to promote healing and prevent infection.
Beyond that, the resident also had deep tissue injuries present on his heel which had not been documented in the chart.
In practice, much of the detection of new skin breakdowns is done by CNA’s. It is part of the responsibility of CNA’s to inspect the skin of the residents when getting them dressed, changing them after an episode of incontinence, or getting them dressed. Often in their early stages bed sores may appear as a reddish discolored area. It isn’t the job of the CNA to decide what it is – that is the role of the nurse. And if a nurse determine that a new bed sore is present, then it is her job to notify the doctor about the presence of a new bed sore or a decline in an existing wound. At that point, the doctor can issue orders for care and the resident’s care plan for bed sores can be updated.
When the IDPH inspector was in the nursing home, she also discovered that this resident had dark burgundy/purple fluid filled blister. This is a near-classic description of a deep tissue injury, which is a type of pressure ulcer. Typically, deep tissue injuries are caused by a combination of pressure and shear. Shear is one of the specific risk factors for developing a bed sore under the Braden scale, and it is the role of the nursing staff to eliminate or reduce the resident’s exposure to shear. Either way, the doctor had not been notified of the presence of the new pressure ulcers to the residents heel even though reddening of the heels had been recorded inthe resident chart several weeks earlier. This appears to be the onset of a new bed sore which was never reported to the doctor, which delayed the start of care and changes to the resident’s care plan.
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