Failure to Follow Physician Orders for Wound Care and Dressing Changes
Penalty
Summary
The facility failed to provide wound treatments and dressing applications in accordance with physician orders for one resident reviewed for wound care and treatment services. The resident, who had multiple complex medical conditions including type II diabetes mellitus with a foot ulcer, chronic kidney disease stage four, atrial fibrillation, anemia, heart failure, depression, above-the-knee amputation of the left leg, non-pressure chronic ulcer of the right foot, absence of right toes, and hypertension, was admitted to the facility and later readmitted from the hospital with specific wound care orders. These orders included detailed instructions for cleansing, dressing, and frequency of dressing changes for wounds on the right foot, heel, and calf. Observations revealed that the resident was found with a soiled gauze-wrapped dressing and a fracture boot on the right lower extremity, with no border foam dressing present on the right calf as ordered. Further inspection by the wound specialist and RN confirmed that the dressing on the right calf had not been applied and the existing dressing was heavily soiled and undated. The medical record lacked documentation of dressing changes to the right calf since the resident's return from the hospital, and the right foot dressing had not been changed for several days. The DON verified that the wound treatments were not completed as ordered, and facility policy required wound treatments to be provided according to physician orders.