Failure to Implement Wound Physician Recommendations for Wound Care
Penalty
Summary
The facility failed to review and implement wound physician treatment recommendations for a resident with significant medical conditions, including necrotizing fasciitis, septicemia, and diabetes mellitus. The resident was cognitively intact and had documented care plans and protocols in place for skin impairment and wound care, which required weekly monitoring and adherence to physician-ordered treatments. Despite these protocols, the facility did not update or implement the wound physician's recommendations for wound care treatments over several months, as evidenced by a lack of corresponding physician orders and treatment administration records. The wound physician made specific recommendations for the treatment of the resident's post-surgical right buttock wound and an abdominal skin tear, including the use of hypochlorous acid solution (vashe), gauze island dressings, and bacitracin. These recommendations were documented in the wound evaluation and management summaries and communicated verbally to facility staff. However, the facility's physician orders did not reflect these recommendations, and the recommended treatments were not initiated in a timely manner. For example, the order to apply gauze to the abdominal wound was not implemented until 50 days after the initial recommendation and only after the surveyor raised the concern. Interviews with nursing staff, the unit manager, nurse practitioner, medical director, and wound physician revealed a lack of awareness and follow-through regarding the implementation of the wound physician's recommendations. Staff members assumed that the recommended treatments were in place, but documentation and direct observation confirmed that the orders had not been updated and the treatments were not being provided as prescribed. The facility's failure to ensure that wound care recommendations were reviewed and implemented resulted in a deficiency in providing appropriate treatment and care according to physician orders and the resident's needs.