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 670068 (X3) Date Survey Completed 03/18/2014
Name of Provider or Supplier Texas Health Presbyterian Hospital Flower Mound Street Address, City, State 4400 Long Prairie Road, Flower Mound, TX
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)
A0395 RN SUPERVISION OF NURSING CARE
CFR(s): 482.23(b)(3)

A registered nurse must supervise and evaluate the nursing care for each patient.


This STANDARD is not met as evidenced by:
Based on interviews and record reviews, the hospital failed to ensure Registered Nurses (RN's) evaluated and provided treatment for 1 of 10 patients (Patient #1's) altered skin integrity to the sacrum and/or coccyx identified on admission to Hospital A on 07/15/13. Findings Included: Hospital A: (Patient #1's) ED (emergency department) physician note dated 07/15/13 timed at 20:37 PM, reflected, "Tiny skin split...sacrum..." The 07/17/13 patient progress note timed at 13:45 PM, reflected, "Wife at bedside...states patient has a small healing ulcer on his coccyx and that she put DuoDerm on when he was admitted and wishes to have us address this if necessary...information given to nurse..." The 07/17/13 decubitus body picture timed at 17:45 PM, reflected, "Redness coccyx..." The 07/23/13 patient progress note timed at 07:35 AM, reflected, "Skin condition intact..." The 07/23/13 decubitus body picture timed at 07:35 AM, reflected, "Whole sore unstageable, blanchable reddened bottom..." No documentation was found which indicated treatment was applied to the pressure ulcer to the sacrum and/or coccyx. (Patient #1) discharged 07/23/13 to Hospital B. The physician orders dated 07/15/13 through 07/23/13 reflected no treatment orders for the wound to (Patient #1's) sacrum and/or coccyx. Hospital B's progress note dated 07/24/13 timed at 18:45 PM, for (Patient #1) reflected, "Initial asssessment performed by...wound nurse...deep tissue injury to coccyx, linear shaped lighter purple discoloration to bilateral gluteus...sloughing epidermis at coccyx site...site measures 10.0 (cm) by 2.0 cm...probable depth involvement...xenaderm ointment to deep tissue injury twice daily...side to side positioning..." On 03/14/13 at 01:00 PM, Personnel #1 was interviewed. Personnel #1 was asked to review (Patient #1's) medical record. Personnel #1 verified the medical record did not contain any documentation which indicated treatment was provided to (Patient #1's) coccyx and/or sacrum. On 03/18/14 at 09:41 AM, Personnel #4 was interviewed. Personnel #4 stated she could not provide the surveyor nursing education and/or competency regarding pressure ulcer prevention for the nursing personnel. The policy and procedure entitled, "Pressure Ulcer Prevention and Management" with a revision date of 06/10 reflected, "The pressure ulcer prevention and treatment program will include...identifying pressure ulcers at the time of admission, informing the physician of need for wound care...education programs for staff..." The policy and procedure entitled, "Patient assessment/Reassessment with an origination date of 03/10 reflected, "Purpose...to ensure each patient's physical status is assessed to determine the patient's care needs and to ensure patient's changing needs are reassessed in response to treatment and care provided...information generated via a patient's assessment will be integrated with other disciplines to identify and prioritize the patient's need for care and treatment..."