Failure to Ensure Nursing Staff Competency in Wound Care Treatments
Penalty
Summary
The facility failed to implement a measurable evaluation system to ensure that nursing staff were properly trained and competent to perform wound treatments as ordered before being allowed to do so independently. Observations revealed that wound dressings for two residents did not have the required date and initials of the nurse who performed the treatment, as specified in the facility's wound care policy. Additionally, one resident's wound dressing was not large enough to fully cover and protect the wound, leaving a portion exposed to air and potential contaminants. Interviews with staff indicated that the facility assigned various nurses, including those not regularly performing wound care, to conduct wound treatments on weekends. One LPN, who was assigned to perform wound treatments, confirmed she had not received recent training or competency evaluation for wound care and was unaware of the requirement to date and initial dressings. The staff development nurse responsible for training and competency evaluations admitted she did not provide actual training or observe wound care skills, instead relying on self-reported experience from the nurses. She also acknowledged she was not competent in wound care herself and could not evaluate others in this skill. Further interviews with the DON and administrator confirmed that wound care is considered a specialized skill requiring specific training and competency evaluation, which was not being conducted. The staff development nurse's initials on competency forms only indicated that she asked nurses if they had performed the skill before, not that she had observed or evaluated their competency. This lack of a structured training and competency evaluation system resulted in nurses performing wound care without verified skills, leading to improper documentation and inadequate wound coverage for residents.