Failure to Follow Physician Orders for Compression Stockings and Wound Care
Penalty
Summary
The facility failed to follow physician orders for a resident with diagnoses including quadriplegia, seizure disorder, anxiety, and respiratory failure. Physician orders required daily and evening wound care to the lower extremities and the use of compression stockings in the morning and removal in the evening to address edema. Documentation and interviews revealed that the resident did not consistently receive the ordered compression stockings, with records showing they were unavailable on 30 occasions, refused 25 times, and applied only 6 times over a period of more than a month. The resident reported not having the correct stockings, and when stockings were received, they were the wrong size and returned. Staff interviews confirmed that the resident did not have the appropriate stockings and that there was a lack of follow-up with the physician or provider when the ordered supplies were not available or not being used as directed. Further, staff admitted to possible inaccuracies in documentation, with one LPN stating that staff may document treatments as completed when they were not, including the application of compression stockings. The facility's policy emphasized the importance of accurate and timely processing of physician orders, but this was not followed in practice. The outside provider noted that the resident's wounds would likely be healing better if the compression stockings had been used as ordered. Observations confirmed the resident was not wearing compression stockings, and multiple staff acknowledged the lack of follow-up and communication regarding the unavailability and non-use of the ordered medical supplies.