Failure to Provide Timely and Appropriate Wound and Pain Management
Penalty
Summary
The facility failed to provide appropriate treatment and care according to physician orders and residents' needs for three residents. One resident, admitted with multiple diagnoses including dementia and incontinence, experienced significant vaginal pain during peri care. The certified nursing assistant did not apply the prescribed cream for pain relief, instead using Vaseline, and did not notify the nurse for further assessment. Although there were existing orders for A and D ointment and lidocaine cream, these were not administered as directed, and there was no evidence that a gynecology consult ordered for a labial growth was completed. Another resident was observed with a foam dressing on his right elbow, which had a skin tear. Despite having orders for specific wound care treatments upon admission, no treatment was initiated for the elbow wound until four days after admission. Documentation showed a delay in transcribing and implementing wound care orders, contrary to facility protocol requiring orders to be entered onto the treatment administration record within one hour of admission. A third resident was found with a foam dressing to the gluteal cleft and had a history of moisture-associated skin damage (MASD) and vascular wounds. Although the after-hospital care plan included detailed wound care instructions, there were no wound treatment orders or documentation of treatment for the MASD until five days after admission. The wound care nurse confirmed that wound assessments and treatments were not completed in a timely manner, and the required documentation was missing for these residents.