Failure to Initiate Treatment for Non-Pressure Wound
Penalty
Summary
The facility failed to identify and initiate prompt treatment for a non-pressure wound in a resident with multiple complex medical conditions, including hypoxic ischemic encephalopathy, cerebral infarction, congestive heart failure, schizoaffective disorder, and hidradenitis suppurativa. The resident, who was cognitively impaired and dependent on staff for activities of daily living, was admitted with these diagnoses. On review, a nurse identified blood on the resident's pillow and an open wound behind the right ear, initially applying A&D ointment. However, subsequent progress notes and the Treatment Administration Record showed no specific treatment orders for the wound, and the wound persisted with ongoing drainage and staining of the resident's pillow. Multiple observations and staff interviews confirmed the presence of the open wound and the lack of a treatment plan. Housekeeping staff noted dried blood stains on the resident's pillow, and both the resident's representative and a CNA acknowledged the wound had been present for several weeks. An LPN confirmed the wound was identified but not treated, and the nurse practitioner clarified that while there was an order for ointment for dry skin, there was no order specific to the wound behind the ear. The Assistant Director of Nursing also confirmed that no treatment was initiated after the wound was first identified.