Care Plan Not Revised to Reflect Accurate Wound Diagnosis
Penalty
Summary
The facility failed to revise and accurately update a resident's care plan to reflect the correct wound condition. A resident with multiple diagnoses, including acute hematogenous osteomyelitis of the right ankle and foot, stage IV pressure ulcer of the right heel, diabetes mellitus, and peripheral vascular disease, was admitted with a wound on the right heel. Nursing staff and the DON confirmed that the care plan incorrectly identified the right heel wound as a diabetic ulcer, when in fact it was a pressure ulcer. The care plan had not been updated to reflect this change, despite the resident having a skin graft and current physician orders related to the wound. The inaccuracy was acknowledged by the DON, who stated the care plan was not correct and needed revision.