Failure to Provide Timely Wound Care Following Physician Orders
Penalty
Summary
A deficiency occurred when staff failed to follow physician orders for wound care for a resident with necrotizing fasciitis, sepsis, type II diabetes, polyneuropathy, and anxiety disorder. The resident was cognitively intact and had a physician order for negative pressure wound therapy (NPWT) to be applied to the right foot on specific days and as needed. On the day of the incident, the resident independently removed the NPWT device after showering and wrapped her foot in a towel due to a strong odor. She repeatedly requested assistance from various staff members, including a CNA, nurse, social service director, and front desk staff, to have the wound care nurse attend to her wound, but her requests were not acted upon or communicated effectively to the wound care nurse. Multiple staff members, including the CNA, nurse, social service director, and front desk staff, either assumed the wound care nurse would see the resident during rounds or did not follow up after initial attempts to contact the wound care nurse. The wound care nurse reported not receiving any requests or reports about the resident needing wound care after her initial morning encounter. The facility's protocol required staff to call the wound care nurse directly if a resident requested wound care, but this was not done. Documentation for the day showed no record of wound care being provided, and the only progress note indicated the resident was non-compliant with prescribed wound care, had removed her wound vac, and was upset, eventually insisting on hospital transfer. The resident waited approximately five hours without receiving wound care, ultimately calling 911 herself and being transported to the hospital. Upon EMS arrival, the resident and her husband reported that she had been requesting wound care and pain management for several hours without response. EMS documented a large, deep, weeping wound on the right foot, and hospital records confirmed the resident presented with pain, erythema, and exposed tendon, with no wound care provided that day. The facility's grievance and policy documents further confirmed the lack of adherence to physician orders and wound care protocols.