Failure to Follow Physician Orders for Wound Care
Penalty
Summary
A resident with multiple complex medical conditions, including severe protein-calorie malnutrition, chronic respiratory failure, and several infections, was admitted and readmitted to the facility. The resident's care plan documented a skin tear on the left outer forearm, and physician orders specified that the wound should be cleaned with wound cleanser, patted dry, covered with xeroform, and then a dry dressing, with changes scheduled for specific days and as needed. During an observed wound care procedure, an LVN did not follow the physician's order and instead applied a hydrogel dressing rather than the prescribed xeroform dressing. The LVN initially stated that hydrogel and xeroform were the same, later acknowledging after speaking with the supplier that xeroform should have been applied under the hydrogel. The DON confirmed that the correct dressing was not used and that the procedure should have followed the physician's orders. The facility's wound care policy also required the use of appropriate, physician-ordered products.