Failure to Follow Physician Orders for Surgical Wound Care
Penalty
Summary
The facility failed to follow physician orders for the care of a surgical wound for a resident with a right lower leg fracture and a right shoulder fracture. The resident, who had moderately impaired cognition and required staff assistance with activities of daily living, had a surgical wound with orders to keep the dressing clean, dry, and in place until a post-operative appointment. On one occasion, a nurse noted the dressing was saturated with drainage and replaced it with clean gauze, but there was no evidence in the medical record that the surgeon was notified of the drainage or the dressing change, as required by the physician's orders. Subsequently, staff discovered maggots at the end of the gauze dressing on the resident's right leg, with documentation that approximately three dozen maggots were removed from the wound area. The facility's administrative staff confirmed that the physician's orders were to keep the original surgical dressing in place until the follow-up appointment. The facility was unable to provide a policy on following physician orders for surgical wound care when requested.