Delayed Assessment and Intervention for Resident Wound
Penalty
Summary
A deficiency occurred when the facility failed to provide timely assessment and intervention for a wound identified on a resident's left foot. Upon admission, the resident, who had multiple diagnoses including diabetes, Alzheimer's disease, functional quadriplegia, bipolar disorder, and polyneuropathy, was noted by the Assistant Director of Nursing (ADON) to have a wound on the left foot. However, the admitting nurse did not conduct a wound assessment or notify the provider for intervention at that time. The resident's care plan directed staff to check for skin breaks and treat promptly as ordered, but the Medication and Treatment Administration Records for the following months did not reflect any intervention for the wound. For 48 days after admission, there was no documented assessment or provider notification regarding the wound. The wound was only re-identified when a CNA noticed blood on a transfer device and the resident's sock, at which point the wound was found to be black, foul-smelling, and measured 3 cm x 3 cm. The nurse then cleansed the wound, applied a protective foam boot, and notified the physician, who ordered antibiotics. Further assessments and wound care were initiated only after this delayed recognition, and the wound was later determined to be an in-house acquired wound of unknown duration. Interviews with staff revealed that the ADON had expected the nurse to notify the physician and family and initiate treatment upon initial identification of the wound, but this did not occur. The facility's policies required prompt assessment, provider notification, and treatment implementation for new skin areas, but these steps were not followed. The delay in assessment and intervention was attributed in part to communication challenges and the use of agency nurses during the period in question.