Failure to Honor Resident's Preference for Wound Care Timing
Penalty
Summary
The facility failed to honor a resident's preference regarding the timing of wound care. The resident, who had quadriplegia, chronic pain, anxiety, depression, and a chronic sacral pressure ulcer, had physician orders for wound care to be performed twice daily on both day and night shifts. Documentation showed that wound care was frequently attempted during the night shift, but the resident repeatedly refused, stating a preference for wound care to be done during the day. Despite these refusals and the resident's clear requests, staff continued to attempt wound care at night, and there was no documentation of any adjustment to the care plan or physician orders to accommodate the resident's wishes. Nursing progress notes indicated multiple instances where the resident refused wound care at night and requested it be performed during the day. Interviews with the DON and Unit Manager confirmed awareness of the resident's refusals and preferences, but there was no evidence in the medical record, care plan, or orders that the timing of wound care was discussed or changed in response. Additionally, there was a lack of documentation explaining missed wound care opportunities or refusals on certain days.