Failure to Protect Wound from Insect Contamination and Provide Physician-Ordered Wound Care
Penalty
Summary
A deficiency occurred when the facility failed to protect a resident's wound from insect contamination and did not provide appropriate, physician-ordered wound care. The resident, who had multiple comorbidities including chronic osteomyelitis, diabetes with skin complications, heart failure, and a history of alcohol dependence, had physician orders for specific wound care treatments. These included cleansing, application of topical medications, and either covering with a dry dressing or leaving the wound open to air, depending on the most recent orders. However, documentation and staff interviews revealed that the correct wound care orders were not consistently followed, and a dry dressing was applied to the resident's right foot wound when the current order was for betadine and open to air. During a routine skin sweep, a wound nurse discovered that the resident's right foot wound was covered with a dry dressing, contrary to the physician's most recent order. Upon removing the dressing, the nurse found the wound infested with over fifty maggots (myiasis) within necrotic tissue. The nurse, unfamiliar with treating maggot infestations and unable to reach the infection preventionist, contacted the physician and arranged for the resident's immediate transfer to the hospital. The resident reported that wound dressings were changed only about once a week, and that they were not informed about the condition of their feet. Hospital records confirmed the presence of maggots in the wound and documented subsequent treatment for infected wounds, sepsis, and osteomyelitis. The resident ultimately required a right above-the-knee amputation, was placed on a feeding tube and urinary catheter, and later became unresponsive, leading to a hospice recommendation. Staff interviews indicated a lack of communication regarding changes in the wound's condition and failure to notify the physician or follow up with appropriate wound care orders.