Failure to Follow Wound Care Orders Resulting in Wound Deterioration and Hospitalization
Penalty
Summary
The facility failed to follow wound treatment orders for a resident with a surgical wound on the left lower leg, which ultimately led to the deterioration of the wound and required hospitalization and surgical intervention. The resident had a history of surgery on the knee, followed by infection and subsequent treatments, including oral antibiotics and wound care. Despite the wound nurse practitioner's order for daily iodoform packing to manage tunneling and drainage, the wound care was only performed on Mondays, Wednesdays, and Fridays, contrary to the prescribed daily regimen. Interviews with facility staff revealed a lack of awareness and adherence to the wound care orders. The wound nurse practitioner emphasized that daily packing is necessary to prevent infection and promote healing, especially in residents colonized with MRSA. However, the wound care was not performed as ordered, and the wound nurse practitioner was not informed of this deviation. Documentation showed inconsistencies in the transcription of physician orders, with some orders omitting the required packing and others specifying a reduced frequency of dressing changes. As a result of the failure to follow the prescribed wound care regimen, the resident's wound developed increased drainage, tunneling, and signs of infection. The wound deteriorated, leading to the need for hospital transfer, where an abscess and possible osteomyelitis were identified. The resident underwent an incision and drainage procedure, received intravenous antibiotics, and returned to the facility with a wound vacuum in place. The facility's policy required adherence to physician orders for wound care, but this was not followed in the resident's case.