Failure to Update and Implement Wound Care Orders
Penalty
Summary
The facility failed to ensure that treatment orders were updated and completed as ordered for a resident with multiple non-pressure related skin conditions. The resident had a history of orthopedic aftercare following surgical amputation, chronic osteomyelitis, cellulitis of both lower limbs, and type 2 diabetes mellitus. The resident was cognitively intact and had documented skin integrity impairment, with care plan interventions requiring evaluation and treatment per physician orders. Initial physician orders specified wound care regimens for various areas of the right foot, including cleansing, application of Xeroform, and dressing changes on specific days. Subsequent to wound care and podiatry appointments, new orders were provided, including the use of Iodosorb, Betadine, and changes to dressing frequency and materials. These updated orders were documented in after-visit summaries and progress notes but were not transcribed into the physician order summary or implemented in the medication and treatment administration records. The wound care nurse acknowledged entering the updates in progress notes but not updating the official physician order summary, resulting in the failure to carry out the new wound care instructions as directed.