Failure to Follow Physician's Orders and Professional Standards of Practice
Penalty
Summary
The facility failed to ensure that residents received care in accordance with professional standards of practice and physician's orders for two residents. One resident, admitted with chronic peripheral venous insufficiency and bilateral lower extremity edema, had a physician's order to offload heels when in bed every shift. However, during multiple surveyor observations, the resident was found in bed with heels resting directly on a pillow, rather than being properly offloaded as ordered. The Director of Nursing Services confirmed that the observed positioning did not meet the physician's order. Another resident, admitted with cellulitis of the right lower extremity, had a physician's order for wound care specifying cleansing with Vashe, application of Santyl, and covering with gauze and kerlix wrap once daily. Nursing documentation and direct observation revealed that hydrofera blue, a wound dressing, was applied to the wound without a corresponding physician's order. Staff interviews confirmed the absence of an order for hydrofera blue, and the DNS acknowledged that staff are expected to review and follow physician's orders prior to performing dressing changes.