Caring Heart Rehabilitation And Nursing Center (April)

Based on observation, staff interviews, review of facility policy and clinical record review it was determined that the nursing home failed to follow physician’s orders. The findings included the following: The resident’s MDS dated March 15, 2013 revealed that the resident had severe cognitive mental impairment and that the resident needed extensive assistance with care needs. In observation of Resident R206 on April 4, 2013 at 12:15 p.m. revealed that Osmolyte 1.5. was being administered to the resident and that approximately 900 cc’s of the 1000 cc’s that was started on April 3, 2013 at 9:00 p.m. had been administered to the resident. In an interview with Employee E4, a licensed nurse, on April 4, 2013 at 1:30 p.m. confirmed that the incorrect formula feeding tube was administered. In review of the facility’s policy and procedure titled, Tube Feeding dated February 2011 revealed the physician’s orders. The order instructed that the prescribed medicine should be taken twice a day for 14 days. In review of the resident’s MAR, dated March 30 until April 2013 at 1:50 p.m. confirmed that the wrong biotic was administered to the resident.

The resident’s MAR indicated on April 1, at 11:30 p.m. and 4:00 p.m. that the resident’s blood sugar was 291 and 223 mg.dl. and required insulin coverage.However, there was no evidence that the resident’s blood sugar coverage was administered. In an interview with Employee E4, on April 5, 2013, at 11:10 a.m. confirmed this finding. In review of the facility’s policy and procedure titled Administration of Insulin dated June 2009 revealed the injection of insulin shall be charted. In observation of R206’s wound care on April 5, 2013 at 12:05 p.m. with Employee E4 revealed that the resident had stage IV pressure ulcer requiring a wound vac. During the removal of the wound vac, the resident had grimaced and moaned and indicated leg pain. An interview with Employee 4, confirmed that the resident seemed to be having pain lately during wound care and that the resident was not pre-medicated for wound care and that there was no prn. In review of physician’s orders, dated March 28, 2013, revealed a new order for Vital 1.5 cal at 40 cc/hour when available.

In observation of the resident and the feeding tube on April 4, 2013 at 12:30 p.m. revealed that the resident was receiving Glucerna at 1.2 at 40 cc/hour.An interview with Employee E3 on April 4, 2013 at 2:00 p.m. confirmed that the Resident R80 was receiving the wrong rate of tube feeding and that the Vital 1.5 that the physician ordered on March 28, 2013 was still unavailable from the supplier. An interview with the licensed unit manager on the fourth floor housing unit, Employee E10, at 10:30 a.m. on April 5, 2013 revealed that the resident left the facility at 6:30 a.m. and returns to the nursing home at noon on the scheduled days of the resident’s medical treatment.On the days that the resident was out of the facility, the nursing staff was not administering the respiratory treatment as ordered.