Failure to Ensure Appropriate Care for Surgical Wound and Hospice Orders
Penalty
Summary
The facility failed to provide appropriate treatment and care according to physician orders and residents' preferences and goals in several instances. For one resident with a dehisced surgical incision, there was no documentation that the facility contacted the surgeon as directed in the physician's progress note, nor was the dehiscence consistently documented in nursing notes. The resident was later observed interfering with the wound and required hospital intervention for wound closure. Interviews with nursing staff indicated a lack of awareness of the wound's dehiscence prior to the resident's hospitalization, and the corporate nurse consultant confirmed that the facility should have clarified the physician's note and notified the surgeon. Additionally, the facility failed to ensure that two residents receiving hospice services had appropriate physician orders for hospice care. One resident switched hospice providers, but there was no order for the initial hospice admission, and coordination of care with the first hospice provider was lacking due to their irregular visit times. Another resident was assessed and care planned for hospice services, but a physician's order for hospice was not present in the clinical record until months after hospice admission. Staff interviews confirmed reliance on hospice company hard charts rather than facility physician orders to identify hospice status.