Failure to Provide Wound Care and Follow Physician Orders for Compression Therapy
Penalty
Summary
A male resident with a history of venous insufficiency and peripheral vascular disease was admitted to the facility and had physician orders for TED hose to be applied daily for edema management, with documentation required if refused. Despite these orders, there was no evidence on the treatment administration record that the TED hose were applied, and staff interviews revealed that the resident was not offered the TED hose, nor were they present in his room. Instead, the resident continued to wear unna boot compression dressings, which had been discontinued by physician order, for over 30 days. The dressings were observed to be dirty, discolored, undated, and in direct contact with the floor, and had not been changed since their application. Staff interviews indicated a lack of communication and follow-through regarding the change in orders from unna boots to TED hose. The wound care nurse (WCN) was unaware that the resident still had the unna boots on, and the primary nurse did not ensure their removal. The nurse practitioner and DON were also unaware of the resident's continued use of the unna boots and the lack of TED hose application. The resident denied refusing the TED hose and stated that staff had not offered them. Facility policy did not provide guidance on discontinuing wound care orders, contributing to the failure to provide care in accordance with physician orders and the resident's care plan.