Failure to Clarify and Implement Physician Orders for Skin and Wound Care
Penalty
Summary
Nursing staff failed to clarify and obtain appropriate physician's orders for the treatment of skin impairments for one resident. The facility's policy required licensed nurses to verify and clarify physician orders, document adverse effects or refusals, and correct discrepancies with the physician or nurse supervisor. For the resident in question, clinical records showed a history of lymphedema and chronic lower extremity wounds, with recommendations from hospital discharge, wound specialist, and podiatrist for specific wound care, compression wrapping, and leg elevation. However, the treatment orders in place did not specify all required interventions, such as cleansing with soap and water, application of sterile pads, or compression wrapping, and there was no clarification of the podiatrist's recommendation for leg elevation. Observations revealed the resident had a weeping right lower extremity wound and was seated in a wheelchair without leg rests, with feet directly on the floor and no care plan for leg elevation or scheduled naps to elevate the legs. Interviews with the resident and LPN confirmed that the current treatment orders were unclear, and staff were unsure about the application of prescribed skin treatments or their compatibility with other treatments. Documentation inconsistencies were also noted regarding the frequency and location of skin treatment applications. These failures resulted in the resident not receiving care in accordance with physician orders, resident preferences, and established care plans.