Failure to Provide Daily Wound Care as Ordered
Penalty
Summary
A resident with multiple medical conditions, including multiple pelvic fractures, pustular psoriasis, diabetes mellitus type 2, moderate protein malnutrition, hyperlipidemia, and low back pain, was admitted to the facility and had physician orders for daily wound care to the right dorsal foot and left lower extremity. The orders specified cleansing with in-house wound cleanser, application of SilvaSorb gel, and appropriate dressings to be changed daily and as needed. The resident's care plan also documented the presence of pressure injuries and pustular psoriasis, with interventions in place for wound management. Despite these orders, review of the treatment administration record indicated that wound care was signed as completed on a specific date. However, observations on subsequent days revealed that the dressings on the resident's left foot, left leg, and right foot were dated from a previous day, indicating that the daily wound care had not been performed as ordered. An RN confirmed that the dressings in place were not changed daily as required by the physician's orders, resulting in a failure to provide the prescribed wound care.