Failure to Follow Physician Orders for Wound Care and IV Antibiotic Administration
Penalty
Summary
The facility failed to follow physician orders for two residents regarding wound care and intravenous antibiotic administration. For one resident with a wound on the lower left leg, observation revealed that the dressing was not dated or initialed, and part of it was peeling off. The resident reported not having received wound care for four days. Review of the physician's order specified a detailed wound care regimen, including cleansing, application of collagen powder and calcium alginate, covering with an ABD pad, wrapping with kerlix and an ACE bandage, and offering pain medication prior to treatment, to be performed every shift. The Wound Care Nurse confirmed the dressing was incorrect and not applied as ordered, and the DON stated that dressings should be applied per order and dated. For another resident readmitted with multiple serious diagnoses, including sepsis and malignancies, the facility failed to administer the intravenous antibiotic Meropenem as prescribed. The physician ordered Meropenem 1 gram IV every 8 hours for four doses, but the medication was instead scheduled and administered according to the facility's standard three times daily (TID) schedule, not at the prescribed intervals. The DON acknowledged that the every-8-hour schedule was not discussed with the physician and the medication was entered into the system as TID. Both the pharmacy consultant and the physician confirmed that the medication should have been administered every 8 hours as ordered.