Failure to Follow Physician Orders for Wound Care and Arrange Medical Appointment Transportation
Penalty
Summary
The facility failed to provide wound care to a resident with bilateral arterial and venous ulcers according to physician orders. The resident, who was cognitively intact and required assistance with most activities of daily living, had physician orders for bilateral unna boots to be applied from toes to knees, with wound cleanser to be used on both lower legs before application. During an observed wound care session, the Wound Nurse only cleansed the open ulcer areas and did not cleanse the entire lower legs, including areas with dry skin, before applying the unna boots. The Wound Nurse stated she was unfamiliar with the resident's wound care and believed the order was unclear, but did not seek clarification from the physician. Both the DON and Administrator confirmed that the expectation was for the nurse to follow the physician's order and to clarify any uncertainties before proceeding. Additionally, the facility failed to ensure transportation was arranged for a resident to attend a scheduled gastroenterology appointment. The resident, who was severely cognitively impaired, dependent for all care, and had a feeding tube, had a physician's order for a GI consultation. The appointment was documented in the facility's appointment book, but the resident did not attend, and no transportation was arranged. The Transportation Scheduler reported that he did not schedule EMS transportation and was unsure who was responsible for doing so. The Social Worker, who was responsible for making appointments, was unavailable for interview, and the former ADON did not recall why transportation was not arranged. The Administrator stated that the expectation was for transportation to be scheduled so residents would not miss appointments. These deficiencies were identified through observations, record reviews, and interviews with staff and family members. The failures included not following physician orders for wound care and not ensuring necessary transportation for a medical appointment, both of which were directly observed or confirmed by staff and documentation.