Unqualified Staff Performed Pressure Ulcer Wound Care
Penalty
Summary
The facility failed to maintain professional standards of quality in the care of residents with pressure ulcers. Certified Nursing Assistants (CNAs) were observed removing dressings from pressure ulcers, a task outside their scope of practice, as confirmed by both the Director of Nursing and the Indiana Nurse Aide Curriculum. In one instance, a CNA removed a soiled dressing from a resident's sacral wound prior to wound care being performed by the Wound Nurse, despite facility policy and state guidelines prohibiting CNAs from performing such actions. Additionally, Qualified Medication Aides (QMAs) were documented as having signed out and, according to interviews and records, performed wound care treatments for residents with stage 3 and stage 4 pressure ulcers. Physician orders specified detailed wound care regimens for multiple residents, but the Treatment Administration Records (TARs) showed that QMAs completed and documented these treatments on several occasions. The DON confirmed that QMAs are not permitted to perform pressure ulcer treatments, and facility policy only allows QMAs to perform minor skin treatments, such as those for stage 1 pressure ulcers. The residents involved had significant medical histories, including diagnoses such as osteomyelitis, vascular dementia, major depressive disorder, bone cancer, and diabetes, and were dependent on staff for care. The deficiencies were identified through observation, record review, and interviews, including a family member's report of witnessing QMAs performing pressure ulcer treatments. These findings demonstrate that unqualified staff performed wound care tasks, contrary to professional standards and facility policy.