Lafayette-Redeemer (August 22nd)

Based on interview with staff and observation, it was determined that the nursing home failed to ensure that resident privacy was respected during treatments and medication administration for three of 22 residents reviewed. The findings included the following: Observation of the medication pass on August 20, 2013 at 11:45 a.m. in a undisclosed room it was observed that Employee E3, a registered nurse, was observed injecting an insulin injection to Resident R109, in the resident’s right upper arm. Residing in this room, at the time, was Resident R109, awaiting the noon time meal. Resident R109’s granddaughter was present, sitting on the resident’s bed. The door to this room was opened in the hallway. Employee E3 failed to pull the privacy curtain and/or close the bedroom door prior to administering the injection to Resident R109. In continued observation of the medication pass on August 20, 2013, at 11:55 a.m., revealed that Employee E3 entered the undisclosed room and administered an insulin injection into Resident R109’s abdomen. The door to this room remained opened and Employee E3 failed to pull the privacy curtain prior to administering the resident’s insulin.

In an interview with Employee E3, on this date at 12:05 p.m., it was confirmed that the resident’s privacy curtains and/or bedroom doors should have been closed to prevent residents from being viewed during the administration of the medication via injection. During observation of wound treatment to Resident R32 on August 22, 2013, at 11:30 a.m., Employee E6, a licensed nurse, was observed providing wound care to the resident’s back pressure ulcers. The resident was positioned in a side lying position in bed with the dressings removed and the pressure ulcers exposed to view. The door to this resident’s room was opened in the hallway. Employee E6 failed to pull the privacy curtains and/or close the bedroom door prior to administering treatment to Resident R32. In an interview with Employee E5, unit manager, immediately following the procedure confirmed that per facility policy that the privacy curtains should have been completely closed during the wound treatment to avoid exposing the resident’s body and/or wounds to other persons.

Based on review of clinical records, facility policy, observations and resident and staff interviews, it was determined that the nursing home failed to assess residents for pain before a wound treatment, did not obtain/clarify physician’s orders. The findings included the following: In review of Resident R32’s clinical record revealed that the resident had been admitted to the facility on an unspecified date with an undisclosed diagnosis. In further review of the clinical record indicated that on August 20, 2013, at 10:00 p.m., indicated that cultures obtained from the resident’s back tested positive for an undisclosed medical condition. A treatment observation on August 21, 2013 at 11:30 a.m., to Resident R32 revealed Employee E5, unit manager, and Employee E6, a licensed nurse, providing wound care to multiple wounds located on the resident’s back. During the treatment to the third wound, the resident began to moan loudly, and told the staff that it burned. Employee E6, a licensed nurse, advised Resident R32 that the resident has received pain medication at 10:00 a.m., prior to the start of treatment, and wasn’t due for any more pain medication.