Resident Laceration During Dressing Removal
Penalty
Summary
A deficiency occurred when a resident sustained a laceration to her left lower extremity during a dressing removal performed by an LPN. The incident took place after the resident's family member requested the removal of a dressing on the resident's left knee, citing concerns that it was too tight. The LPN, who was in the middle of a medication pass, paused her duties to address the request. She used bandage scissors to cut through the gauze dressing, inserting the dull end under the dressing. During the process, the resident moaned, and upon removal of the gauze, a superficial cut approximately eight centimeters long was discovered on the resident's skin, with scant bleeding present. The resident had a medical history significant for liver disease, dementia, ascites, and edema, and was severely cognitively impaired and dependent on staff for most activities of daily living. The dressing that was removed had been in place for several days and was covering a pre-existing V-shaped skin tear. The LPN attributed the injury to the tightness of the dressing and the presence of edema, which made the skin puffy and more susceptible to injury. The LPN acknowledged that unwrapping the dressing, rather than cutting it, would have been a safer approach given the resident's condition. Following the incident, the laceration became infected, requiring treatment with an oral antibiotic and topical bacitracin. The facility's policy on wound and skin care emphasized the need for care when removing all dressings and tapes. The family member present at the time expressed concern about the nurse's competence and the additional harm caused to the resident, who had to recover from both the original wound and the new laceration.