Failure to Follow Physician's Orders for Wound Care
Penalty
Summary
The facility failed to follow physician's orders for wound care treatment for a resident with a skin tear on the right wrist/hand. The resident, who was admitted with diagnoses including parkinsonism, major depressive disorder, dysphagia, and neurocognitive disorder with Lewy bodies, was documented as lacking the mental capacity to make medical decisions and was dependent on staff for daily activities. The care plan indicated that skin tears should be treated per facility protocol, and an active physician's order specified cleansing the wound with normal saline, patting dry, applying xeroform, and covering with a dry dressing. During observation, the resident's skin tear was found to be scabbed and open to air without a dressing. The LVN present was unaware if the wound should be covered, stating that a treatment nurse typically performed wound care. The DON later stated that the wound did not need to be covered since it was scabbed, but acknowledged that if there was an order, it should be followed. The facility's wound care policy required following physician's orders and care plans for wound treatment.