Lack of Competency and Training in Wound VAC Application
Penalty
Summary
The facility failed to ensure that nursing staff providing wound care and applying a wound VAC possessed the necessary competencies and training. A resident with significant medical needs, including respiratory failure, ventilator dependence, diabetes, and a history of unstageable and stage 4 pressure wounds, was dependent on staff for all care. The care plan and treatment administration record required specific wound care interventions, including the use of a wound VAC. However, observations and staff interviews revealed that the LPN responsible for wound care and wound VAC application had not received formal training in these areas and relied on self-directed learning. Further interviews with facility staff, including another LPN, the DON, and the Administrator, confirmed that there was no designated, formally trained wound care nurse, nor was there a facility policy for wound care or wound VAC use. The staff member identified as the wound care nurse performed all wound measurements and VAC changes without formal training, and the facility lacked structured guidance or protocols for these procedures.