Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 531311 (X3) Date Survey Completed 11/17/2011
Name of Provider or Supplier Crook County Hospital Street Address, City, State 713 Oak Street, Sundance, WY
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
C0298 NURSING SERVICES
CFR(s): 485.635(d)(4)

A nursing care plan must be developed and kept current for each inpatient.


This STANDARD is not met as evidenced by:
Based on medical review, staff interview, and review of policies and procedures, the facility failed to develop, implement, and/or revise care plans for 3 of 22 sample acute care patients (#9, #10, #14). The findings were: 1. According to the history and physical dated 10/22/11, patient #10 was admitted for chest pain resulting from a fall that morning. Review of the 10/22/11 fall risk assessment showed the patient was at high risk for additional falls. Review of the undated care plan showed "Increased susceptibility to falling that may cause physical harm R/T [related to] history of fall." However, the only interventions the facility instituted were to have a call light in the patient's room, use appropriate (but unidentified) assistive devices, and use a "tab" alarm and bed alarm. The goal was to be free of injury throughout the hospital stay. The following concerns were noted: a. Specific, individualized, interventions were not developed to address the patient's high risk for falls. b. The plan was not revised after the patient was started on narcotics for pain control; due to the side effects, narcotics increased the risk of falls. c. The initial care plan did not address confusion and was not revised when confusion was identified. d. Safety when sleeping in a reclining chair versus the bed was not addressed. Review of nursing documentation timed at 4 AM on 10/28/11 showed the patient was "found face down on the floor with his/her legs entangled in the reliner" chair and with bruising and a laceration to the face. There was no evidence the "tab" alarm had been utilized. 2. Review of the medical record showed patient #9 was admitted to acute care on 11/2/11. Review of the admission orders showed the physician ordered wound care but did not specify what was to be done. Review of the care plan showed the patient was at risk for increased damage to his/her skin but the interventions were to "keep area dry..., reposition, apply appropriate cream to area bilat [bilateral] buttocks..." The care plan failed to identify the area to keep dry, specify the frequency of repositioning, or identify the cream to be used. 3. Review of the medical record showed patient #14 was admitted on 1/6/11 for acute gastroenteritis with diarrhea and severe dehydration and discharged on 1/8/11. The three year old patient received IV fluids and was medicated for fever. Review of the entire medical record showed no evidence a care plan was ever developed. 4. After searching the policy and procedure manual on 11/17/11, at 1:40 PM that day RN #6 stated the facility had no policy and procedure for care plans; this was confirmed by the CNO at 1:41 PM. However, during a previous interview on 11/16/11 at 3:00 PM, the CNO stated care plans for both acute and swing bed patients were to be developed and updated with every assessment.