Failure to Follow Physician Orders for Medication and Wound Care
Penalty
Summary
Surveyors identified that a resident with heart failure and hypertension received blood pressure medications, Coreg and Hydralazine, despite physician orders specifying these medications should be held if the resident's pulse was below 60. The Medication Administration Record showed that the medications were administered on multiple occasions when the resident's pulse was under the specified threshold. The Director of Nursing confirmed that the medications should have been withheld according to the orders. In another instance, a resident with multiple diagnoses, including bone cancer and diabetes, was observed with undated and soiled bandages on his feet and hip, with visible dried and fresh drainage. The resident's skin was noted to be very dry and scaly, and the Wound Nurse was unaware of any cream ordered for the dry skin, despite a physician's order for Aquaphor ointment. Review of the Treatment Administration Record revealed that a prescribed wound treatment for the left hip was not documented as completed for one evening shift, although the Aquaphor application was signed out as completed. Additionally, a third resident with vascular dementia and multiple pressure ulcers was found with outdated and incorrect wound dressings on the left knee and hand. The Wound Nurse discovered that the foam dressing in place was not the oil emulsion bandage ordered by the physician, and the bandages were not dated. The Treatment Administration Record indicated that treatments were signed out as completed, but the actual dressings in place did not match the physician's orders. The Director of Nursing acknowledged that wound and skin treatments should be performed as ordered.