Delayed and Incomplete Implementation of Physician-Ordered Wound Care
Penalty
Summary
The facility failed to monitor and provide timely and adequate treatments for non-pressure skin issues for two residents. For one resident with multiple diagnoses including dementia and chronic kidney disease, there were documented delays in initiating physician-ordered treatments for peri-area moisture-associated skin damage (MASD), a left hip skin tear, and a right inner thigh abrasion. In each case, there was a gap of several days between the identification of the skin issue and the implementation of the corresponding treatment orders, as confirmed by medical record review and interview with the Director of Nursing. Another resident with MASD of the buttocks and venous ulcers of the left shin and ankle also experienced delays in the initiation of ordered wound care treatments. Additionally, a physician's order for pressure relief boots was discontinued by facility staff without a corresponding physician order. The facility's own policy required that wound treatments be provided in accordance with physician orders, but the treatments for this resident's wounds were not started until several days after the orders were written, as confirmed by both record review and staff interview.