By: Linda Winston, RN, MSN, BS, DNS-MT, RAC-CT
A resident with stage IV pressure ulcers and receiving IV antibiotics, along with his mother, reported that the resident’s treatments were not being done. A nurse signed that treatment had been done on 8/24, but upon inspection, the date on the dressing that was in place was 8/23.
When a resident enters a skilled nursing facility with a pressure injury/ulcer, according to the State Operation Manual Appendix PP F314/F686 Pressure Ulcers, “Based on the comprehensive assessment of a resident, the facility must ensure that-(ii) A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing.”
When a nurse does not complete a treatment, but signs that the treatment was completed, this act does not meet professional standards, and the facility is at risk for noncompliance. Appendix PP further states “Key elements of non-compliance to cite deficient practice” could include the facility failed to “Provide treatment, consistent with professional standards of practice, to an existing pressure injury.”
It is important for facilities to have a comprehensive pressure injury/ulcer system that ensures care and treatment of a resident’s pressure injury/ulcer is based on assessment and performed in accordance with the resident’s plan of care and physician orders. Additionally, another important element is competency based education and evaluation of staff’s performance in care and treatment of pressure injury/ulcer upon hire and annually, along with an ongoing monitoring and auditing of pressure injury/ulcer practice.
When completing a comprehensive review of your facility’s pressure injury/ulcer system, please refer to the State Operation Manual Appendix PP, F686 Skin Integrity – Pressure Ulcers, that becomes effective November 28, 2017, by visiting https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/Advance-Appendix-PP-Including-Phase-2-.pdf.
