Failure to Complete and Address Repeated Refusals of Wound Care Treatments
Penalty
Summary
The facility failed to complete multiple wound dressing treatments and did not address a resident's repeated refusals for wound care as required by physician orders. According to the facility's policy, dressing changes should be performed in accordance with physician orders and documented in the Treatment Administration Record (TAR), with staff initialing the electronic TAR after each administration. For one resident diagnosed with dementia, delusional disorder, depression, need for assistance with personal care, and malignant neoplasm of the right breast, there was a physician order for daily wound treatment to the right breast. The resident's care plan also specified that staff were to perform treatments per physician order for a cancer ulcer under the right breast. Record review revealed that, over a period of several months, there were multiple instances where wound treatments were not completed and several occasions where the resident refused treatment. Specifically, the TARs documented missed and refused treatments across July, August, and September, with a pattern of both non-completion and repeated refusals. The Director of Nurses confirmed that staff are expected to complete wound care as ordered and to notify the physician and document in the electronic medical record if treatments are not completed or if there are repeated refusals.