Failure to Follow Physician Orders for Wound Care and Weight Monitoring
Penalty
Summary
The facility failed to follow physician orders and established protocols for wound care and weight monitoring for two residents. For one resident with multiple diagnoses including epilepsy, bullous pemphigoid, and pressure ulcers, staff did not adhere to physician orders for wound care. During wound care observation, Xeroform was applied to a left foot wound without a physician's order, and both the LPN and RN involved could not explain the deviation from the prescribed treatment. The RN acknowledged that it was not within her scope to change a physician's order and that she had not contacted the physician to update the treatment plan. The Director of Nursing confirmed that staff should not alter treatments without proper orders and that a process existed for obtaining new orders if needed. Further deficiencies were identified when a resident was found with multiple undocumented wounds, including an open wound on the coccyx and two wounds on the right buttock, none of which were recorded in the clinical records or reported to the physician. The RN responsible for weekly head-to-toe skin assessments admitted she had not performed these assessments as required, focusing only on the resident's heel ulcers. The facility's weekly skin check documentation did not identify the new wounds, and the Director of Nursing was unaware of these issues until notified by another nurse. Facility policy required daily skin checks by CNAs and weekly audits by nurses, with new findings to be reported and evaluated, but these protocols were not followed. For another resident with morbid obesity and chronic kidney disease, the facility failed to obtain weekly weights as ordered by the physician. The resident was weighed only seven times over a fourteen-week period, and staff interviews revealed a lack of awareness and communication regarding the weekly weight order. The nurse aide was not informed of the need for weekly weights, and the dietitian was unaware of the order, having missed it during her reviews. The Director of Nursing confirmed that weights should have been obtained weekly and that the charge nurse was responsible for ensuring compliance, but could not explain the missed weights. Facility policy required multidisciplinary monitoring and intervention for weight changes, but this was not implemented as ordered.