Failure to Implement and Document Wound Care Orders for Skin Integrity
Penalty
Summary
The facility failed to follow and implement wound care orders for a resident with moisture associated skin damage (MASD) to the buttocks. The resident, who was cognitively intact, ambulatory, and independent with most activities of daily living, had a care plan indicating a potential for skin integrity issues due to urinary incontinence, but was not at risk for pressure ulcers according to the most recent assessments. Despite this, the resident developed MASD, and wound care orders were issued by the nurse practitioner, including specific instructions not to use adhesive dressings and to ensure that any cushions or pads used by the resident were covered with a cloth pillow case to wick away moisture. Observations and interviews revealed that these wound care interventions were not consistently implemented. The resident was repeatedly observed sitting on a cushion without a cloth or pillow case, contrary to the wound care plan. Staff interviews confirmed that the intervention to cover cushions with a pillow case was not included in the resident's care plan or Kardex, and nursing assistants were unaware of the requirement. Additionally, there were instances where staff applied dressings to the affected area despite explicit orders not to use adhesives, and the resident reported that staff did not consistently apply prescribed creams and did not communicate with him about the progress of his skin condition. Documentation review further showed that the care plan and Kardex lacked the necessary interventions for moisture management as directed by the nurse practitioner. The facility's policy required that interventions be care planned according to resident assessment and risk factors, but this was not done in this case. The director of nursing confirmed that orders should be followed and care planned, and staff should be aware of all interventions, but this expectation was not met, resulting in the deficiency.