Failure to Follow Wound Care Orders and Infection Control Practices
Penalty
Summary
The facility failed to provide appropriate wound care for a resident with non-pressure related skin conditions by not following physician orders and professional standards of infection control. The resident, admitted for an infected wound on the right foot, had specific physician orders for wound care, including the application of collagen, calcium alginate, and self-adherent bandages to the right hallux/plantar and right heel wounds. Observations revealed that the nurse did not apply calcium alginate or self-adherent bandages as ordered, and instead used Medi honey and collagen inconsistently with the prescribed treatment. Additionally, infection control protocols were not followed during wound care. The nurse was observed removing soiled dressings, changing gloves without performing hand hygiene, and treating multiple wounds on the same foot without changing gloves or performing hand hygiene between wounds. The nurse confirmed these lapses in infection control and acknowledged that the physician's wound care orders were not followed. The DON stated that the expectation was for staff to follow physician orders and proper infection control practices, including hand hygiene between each wound care step and between different wounds.