Bridgeway Healthcare & Hospice

“Based on interviews and record reviews, the hospice agency failed to ensure nursing services met the needs of the patients for 1 (#10) of 5 (#10, #11, #12, #13, and #16) patients reviewed for pressure wounds. The agency failed to follow acceptable standards of practice for wound care specifically for complete wound assessments with weekly wound measurements, including the size and stage of the wounds for Patient #10. Review of the Louisiana State Board of Nursing Declaratory Statement Scope of Practice for Registered Nurses - Wound Care Management adapted 02/1999 revealed the following in part: Registered nurses render care that is directed towards the prevention and treatment of wounds. Wounds are a common health care challenge that often occur with or result from chronic disorders such as impaired circulation and malnutrition. Nursing care of skin/wound conditionsinvolves the identification, assessment, management, and ongoing evaluation of patients with alterations in skin/tissue integrity that includes but is not limited to draining wounds, pressure ulcers, and vascular ulcers, and conditions resulting from incontinence, surgical procedures, and/or trauma. Scope of Practice - The Louisiana State Board of Nursing recognizes that assessment, planning,intervention, teaching, evaluation, and supervision are the major responsibilities of the registered nurse in the practice setting. The registered nurse is responsible for performing a nursing assessment and physical examination for preventative and restorative nursing and for providing patient/family teaching. Recognizing that the physician must always prescribe wound care, the following roles are defined to delineate the scope of practice for each member of the nursing team members. The registered nurse initiates appropriate wound preventative measures, stages wounds and collaborates with the wound care team in the implementation and evaluation of nursing interventions as prescribed by an authorized prescriber. Review of the National Pressure Ulcer Advisory Panel Prevention and Treatment of Pressure Ulcers: Quick Reference Guide revealed, in part, the following:Pressure Ulcer Assessment 1. Assess the pressure ulcer initially and re-assess it at least weekly.1.1. Document the results of all wound assessments. Assess and document physical characteristics including: location, Category/Stage, size, tissue type(s), color, peri-wound condition, wound edges, sinus tracts, undermining, tunneling, exudate, and odor. A review of Patient #10s Clinical Record revealed a Start of Care Date of 02/13/2024 with a current Certification Period of 05/13/2024 through 08/10/2024. Further review revealed diagnoses which included, in part, Unspecified Systolic Congestive Heart Failure; Secondary Hypertension; Stage I Pressure Ulcer to Sacrum; and Stage II Pressure Ulcer to Dorsal Side of Left Leg. A review of Patient #10s Visit Schedule revealed once-weekly and PRN Skilled Nurse Visits. A review of Patient #10s Physician Orders revealed, in part, the following: 05/08/2024 – Wound Care to be performed on sacrum and left dorsal side of calf weekly, if soiled, bi-weekly; and05/22/2024 – Stage 1 Pressure Ulcer to Sacrum: apply moisture barrier to reddened areas PRN. Stage II Pressure Ulcer to Left Posterior Calf: Apply triple antibiotic to area, cover with dry dressing PRN. A review of Patient 10s Nursing Visit Records revealed, in part, the following:05/08/2024: Stage 1 pressure wound on sacrum. Stage 2 pressure ulcer on dorsal side of left leg. Further review revealed, in part, the following: Wound #2: Stage II Pressure Ulcer - Left Dorsal Side between Shin and Calf Muscle.05/12/2024 - No measurements documented; and05/16/2024 - No measurements documented. Wound #3: Stage I Pressure Ulcer – Sacrum.05/12/2024 - No measurements documented; and05/16/2024 - No measurements documented. An interview was conducted on 05/23/2024 at 12:20 p.m. with S1DON. She confirmed nursing staff should document weekly wound measurements in the RNs Nursing Visit Record. She confirmed wound measurements were not performed and documented weekly for Patient #10s wounds to the sacrum and left leg.”