Failure to Provide Ordered Foot Care Treatment
Penalty
Summary
A deficiency occurred when the facility failed to provide foot care treatment as ordered by a podiatrist for a resident with a history of stroke and severe cognitive impairment. The podiatrist's note documented a chronic problem with dry skin (xerosis) and included an order for daily application of moisturizing cream to both feet, avoiding the area between the toes, for three months. However, this order was not transcribed into the resident's physician orders or treatment record, and no staff were aware of the order. Observations revealed the resident's feet were very dry with thick, flakey dead skin. Interviews with nursing staff, nursing assistants, the unit manager, and the DON confirmed that none were aware of the podiatrist's order, and the moisturizing cream had not been applied. The unit manager explained that consultant notes were typically reviewed for orders, but in this case, the podiatry note was sent directly to medical records for scanning and was not reviewed. The DON and administrator both stated that consultant notes should be reviewed for orders and entered into the electronic document system, but this process was not followed for the podiatrist's order.