Failure to Provide Timely Wound Care and Implement Physician Orders
Penalty
Summary
The facility failed to provide timely care for surgical incision staple removal for two residents and did not obtain physician-ordered daily weights for another resident. For one resident with a history of fractured femur, mood disorder, and other significant medical conditions, staples from a surgical incision were not removed in a timely manner. The resident's follow-up appointment for staple removal was canceled by the trauma clinic, and although the spouse, who is the POA, requested that the removal be done in the facility to avoid confusion for the resident, there was no documentation of any plan or action to remove the staples until two weeks later. During this period, the resident continued to have the staples in place, and the spouse reported ongoing concerns to the facility. Another resident, admitted with diagnoses including diverticulitis, acute respiratory failure, and recent abdominal surgery, had a surgical incision with staples present on admission. The medical record indicated that the staples remained in place throughout the resident's stay, and there was no documentation of any discussion or order regarding staple removal during the entire admission. Wound assessments noted the presence of the staples, but no further action was documented regarding their removal. A third resident, with a history of myocardial infarction, acute respiratory failure, and pressure ulcers, had a physician's order for daily weights following a cardiology appointment. Although medication changes from the after-visit summary were implemented, the order for daily weights was not entered into the system, and the resident was not weighed daily as ordered. Interviews with staff confirmed that the process for entering new orders from after-visit summaries was not followed, resulting in the omission of the daily weight order.