Failure to Provide Timely Assessment and Treatment of Burn Injury
Penalty
Summary
A resident with a history of diabetes mellitus type II and degenerative disease of the nervous system sustained a full thickness burn to the left foot during wound care. The incident occurred when a nurse prepared a basin of water for the resident to soak his foot prior to applying a treatment for an unrelated skin condition. The nurse checked the water temperature by hand but did not use a thermometer or recheck the temperature after filling the basin. The resident, who had decreased sensation in his feet due to diabetes, initially reported the water felt too hot and removed his foot. The nurse, after assuring the resident the water was not too hot, left the room to gather supplies, instructing the resident to wait. However, the resident placed his foot back in the water, and when the nurse returned several minutes later, a blister had formed on the top of his foot. Following the incident, documentation in the clinical record was incomplete. There was a lack of timely and thorough assessment and description of the burn wound, particularly on the day after the incident. Progress notes indicated the wound worsened over the next two days, with blisters, sloughing, copious drainage, and increased pain. The nurse practitioner did not remove the dressing or fully assess the wound during follow-up visits, and the physician was not immediately involved in the assessment. The resident's pain escalated, and the wound was eventually described as a third-degree burn with significant tissue damage. Due to the severity of the injury and inadequate initial assessment and intervention, the resident required emergency transfer to an acute care burn unit. Hospital records confirmed a full thickness scald burn, necessitating two surgical procedures for debridement and skin grafting. The facility's documentation and care planning did not accurately reflect the burn injury or the subsequent hospitalization, and staff interviews revealed lapses in communication, assessment, and documentation following the incident.