Failure to Follow Physician Orders for Wound Care
Penalty
Summary
The facility failed to ensure that wound treatments for a resident with peripheral vascular disease and type II diabetes mellitus were completed as ordered by the physician. The physician's order specified that betadine should be applied to the resident's right great toe three times daily, but review of the Treatment Administration Record (TAR) showed that the treatment was only provided once daily over a period of more than two weeks. This discrepancy was confirmed by both nursing staff and documentation review. The resident, who had intact cognition, also reported not receiving the expected care for his toe on at least one occasion. Weekly wound and skin assessments indicated that the wound was initially identified and assessed, with ongoing documentation showing improvement in the wound's condition. However, interviews with nursing staff confirmed that the treatment was not administered according to the physician's order, as it was only scheduled and provided once daily instead of three times daily. Observations of the wound by nursing staff described it as improving, with healthy granulation tissue and intact surrounding skin, but the failure to follow the prescribed treatment frequency constituted a deficiency in care.