Failure to Follow Professional Standards in Wound Care and Oxygen Administration
Penalty
Summary
The facility failed to meet professional standards of practice for two residents. In the first case, a resident with a history of diabetes, depression, muscle weakness, and abnormal gait was observed to have open, bleeding, and unhealing wounds on her arms and shoulder due to persistent itching and picking at her skin. Licensed Vocational Nurses (LVNs) did not notify the physician about the resident's continued skin picking and resulting wounds, despite documentation in progress notes and observations by staff. Certified Nursing Assistants (CNAs) also failed to report the resident's behavior and skin condition to the charge nurse, and there was no documentation of skin checks during bathing or showering. The facility's policies and job descriptions required staff to report and document such changes, but these procedures were not followed. In the second case, another resident with chronic respiratory failure, hypoxia, heart failure, and pneumonia was not administered oxygen therapy according to the physician's order. The resident was ordered to receive oxygen at 2 liters per minute (LPM) via nasal cannula, but was observed receiving 5 LPM. The LVN and Respiratory Therapist (RT) could not determine how long the resident had been receiving the incorrect dosage or who had made the adjustment. Both staff members acknowledged that oxygen is considered a medication and must be administered as prescribed. The facility's policies, as well as job descriptions for LVNs and RTs, required adherence to physician orders for medication administration, including oxygen therapy. Interviews with facility staff, including the Director of Nursing (DON), confirmed that the observed practices did not align with professional standards or facility policies. The DON stated that all physician orders and medications must be administered as prescribed, and only authorized personnel should adjust oxygen concentrators. The failures in both cases were corroborated by record reviews, staff interviews, and direct observations, demonstrating a lack of compliance with established protocols for wound care and medication administration.