Failure to Follow Physician's Order for Daily Wound Care
Penalty
Summary
A deficiency was identified when staff failed to follow a physician's order for wound care treatment for one resident with a history of coronary angioplasty and moderate cognitive impairment. The physician's order specified that the resident's right-hand skin tear should be cleaned with wound cleaner, patted dry, and covered with calcium alginate and a dry dressing once daily. However, observations over several days revealed that the resident's bandage had not been changed daily as ordered, with one bandage remaining in place for multiple days. The resident reported that their dressing was changed every six days, and staff interviews confirmed that the dressing change schedule did not align with the physician's daily order. Further investigation revealed that the LPN responsible for the dressing change was unaware of the specific daily order and believed the dressing should be changed on Mondays, Wednesdays, and Fridays or as needed. The Wound Care Nurse, who typically managed these treatments, was on vacation, and the responsibility had shifted to unit nurses. The Direct Health Service confirmed that nurses are expected to follow physician orders for treatments in the absence of the Wound Care Nurse. The failure to administer wound care as prescribed resulted in noncompliance with the facility's medication administration policy and the physician's written orders.