Failure to Follow Physician Orders for Wound Care and Antibiotic Administration
Penalty
Summary
The facility failed to ensure that physician orders were followed for wound treatment and antibiotic administration for a resident with chronic obstructive pulmonary disease and non-pressure wounds on both feet. Observations showed the resident with both feet wrapped in bandages and directly on the ground. Review of clinical records revealed that physician orders for wound care, including cleansing, application of oil emulsion, and specific wrapping techniques, were not consistently followed. Documentation indicated that unna boots were continued after the order for their use had been discontinued, and the prescribed wound care regimen was not administered as ordered on at least one occasion. Additionally, the facility did not obtain a skin culture prior to starting the resident on Cefdinir, an antibiotic, contrary to facility policy. The antibiotic was ordered for a specific duration, but there was inconsistency in documentation regarding the length of therapy, with no clear record of changes to the duration. The facility's policy required medication orders to be accurate and timely, but these standards were not met in this case.