Failure to Ensure Physician-Ordered Appointments and Wound Care
Penalty
Summary
The facility failed to provide necessary care and services for two residents, resulting in deficiencies related to physician-ordered follow-up and wound care. For one resident with acute and chronic respiratory failure, tracheostomy, and congenital malformation of the skull and facial bones, the facility did not ensure attendance at scheduled outpatient appointments for a speech evaluation and a plastic surgeon. Documentation showed that transportation for the appointments could not be arranged due to insurance issues, and the resident ultimately did not attend either appointment, despite physician orders and acknowledgment from the Director of Nursing (DON) that follow-up should have occurred. For another resident, the facility did not follow physician orders regarding wound care after surgery. The resident's order specified removal of a Prevena dressing, but during the procedure, betadine was applied to the surgical incision without a physician's order. This was confirmed by both a Licensed Vocational Nurse (LVN) and the DON, who acknowledged that betadine application required a physician's order. The Administrator and DON confirmed these findings during the survey.