Failure to Implement Care Plan and Wound Treatment for Resident with Hand Contractures
Penalty
Summary
The facility failed to develop and implement a comprehensive and individualized plan of care for a resident with bilateral hand contractures, resulting in a lack of interventions to prevent skin impairment. The resident, who had diagnoses including Alzheimer's disease, muscle weakness, and bone disorders, was dependent on staff for all activities of daily living and was rarely or never understood. The care plan identified a risk for infection and discomfort due to the contractures but did not include any specific interventions. Physician orders were in place for daily wound care and dressings for both palms, but the Treatment Administration Record showed that these treatments were not completed on several dates. Observations confirmed that the resident's hands were contracted, with long and uneven nails, and no dressings were present on either hand during multiple checks. Staff interviews revealed that the resident had not worn palm guards or any protective dressings for an extended period, and attempts to open the contracted fingers were unsuccessful. The Assistant Director of Nursing confirmed that the resident was supposed to have her hands wrapped to prevent the nails from causing wounds, but this had not been done for several weeks. There was no documentation indicating that dressings had been removed and re-applied as needed, contrary to physician orders and facility policy.