Failure to Follow Physician Orders for Wound Care
Penalty
Summary
A deficiency occurred when a nurse failed to provide wound care treatment in accordance with the physician's order for a resident with peripheral vascular disease and a chronic leg wound. The resident's treatment order specified cleansing the wound with normal saline, patting it dry, applying oil emulsion gauze, wrapping with Kerlix, and securing with retention tape every other day. However, during an observation, the nurse was seen removing a different set of dressings, including Coban, Kerlix, a 4x4 gauze pad, calcium alginate, and Xeroform, which were not part of the current physician's order. The nurse admitted to applying these dressings based on memory of past treatments rather than the current order and confirmed there was no physician order for the calcium alginate and Xeroform dressings used. Further interviews revealed that wound treatments are sometimes changed based on wound condition, but the nurse did not seek clarification or new orders from the physician before altering the treatment. The Director of Nursing stated that the nurse should have either applied the current ordered treatment or contacted the physician for clarification upon discovering a change in the wound's condition. Facility policy requires treatments to be administered as ordered by a physician, and any changes to orders must be clarified and documented before implementation.