Failure to Follow Physician's Wound Care Orders
Penalty
Summary
A deficiency occurred when a Licensed Practical Nurse (LPN) failed to follow a physician's order for wound care for a resident with a history of cerebral infarction and diabetes mellitus. The physician's order specified that the resident's left ankle wound should be cleansed with wound cleanser or normal saline, patted dry, treated with gentamicin ointment, and covered with a dry protective dressing such as an ABD pad, then secured with rolled gauze and tape daily or as needed if the dressing became dislodged or soiled. During an observed wound care procedure, the LPN chose not to use the rolled gauze as ordered, stating concern that it might come off if the resident rubbed her legs together. The LPN also acknowledged not replacing the dressing as needed because the rolled gauze was not used, despite the PRN order for replacement upon dislodgement or soiling. The LPN proceeded with the wound care by cleaning the area, applying the prescribed ointment, and covering the wound with a bordered dressing, but omitted the rolled gauze step. The Director of Nursing (DON) confirmed in an interview that nurses are required to follow physician's orders and that failure to do so constitutes a delay in care and neglect. The report documents that the physician's wound care order was not fully implemented as written for this resident.