LPN Performed Unauthorized Procedure on Resident Abscess
Penalty
Summary
A deficiency occurred when a Licensed Practical Nurse (LPN) performed a procedure outside of accepted standards of practice on a resident who had a history of spinal stenosis, anxiety disorder, hypertension, and hypothyroidism. The resident was identified as having a potential for skin impairment and had a new abscess on her back, which was documented by nursing staff. Physician orders were in place for skin assessments and antibiotics, but there were no orders for any invasive procedures such as excision, debridement, or lancing of the abscess. Despite these orders and facility policy, the LPN proceeded to manipulate the abscess after the resident requested assistance. The LPN used lidocaine cream, gauze, and tweezers, and attempted to squeeze the abscess, resulting in pain and bleeding. The LPN did not have a physician's order to perform this procedure and did not use sanitized instruments, as reported by the resident. The Assistant Director of Nursing (ADON) and other nursing staff confirmed that LPNs are not permitted to lance or excise abscesses and that the LPN had been instructed not to intervene in this manner. Following the unauthorized intervention, the resident experienced significant pain and required transfer to the hospital, where further medical intervention was necessary. Interviews with staff and review of facility documentation confirmed that the LPN's actions were not in accordance with professional standards, facility policy, or the scope of practice for LPNs. This failure resulted in actual harm to the resident and was reported to facility leadership.