Failure to Coordinate and Implement Wound Care Orders for Residents with Non-Pressure Wounds
Penalty
Summary
The facility failed to ensure that wound care was provided according to physician orders and residents’ needs for two residents with non-pressure wounds. For one resident with a history of squamous and basal cell carcinoma, there was a lack of coordination and communication between the facility, the wound physician, and the dermatologist. The plan of care for post-surgical wounds was not clarified when two different providers were involved, resulting in conflicting or unclear orders. The wound nurse was not aware of how to access the wound physician’s notes and did not receive direct communication regarding changes in the treatment plan. As a result, outdated wound care orders, such as the continued use of Dakin’s solution, remained in effect beyond the period recommended by the wound physician, and topical antibiotics recommended by the dermatologist were not implemented in a timely manner. Additionally, the facility failed to ensure that nurses responsible for wound care could access and implement the wound physician’s plan of care. The wound nurse reported difficulty obtaining records from the dermatologist and was unaware of the wound physician’s updated recommendations. The interim Director of Nursing was also not aware of the ongoing use of outdated wound care orders. This lack of communication and access to care plans led to inconsistencies in wound care delivery, including the use of incorrect treatments and missed opportunities to follow specialist recommendations. For another resident with diabetic ulcers, there was a delay in initiating wound care treatment orders. Although the wounds were identified upon admission, no treatment orders were entered for several days, and documentation of wound care was missing for multiple dates. Interviews with nursing staff revealed confusion about responsibility for wound care, with several nurses stating they were not trained or informed that it was their duty to perform treatments. This resulted in missed wound care treatments and incomplete documentation for the resident’s diabetic ulcers.