Failure to Follow Physician Orders for Wound Care and Medication Administration
Penalty
Summary
The facility failed to follow physician orders for wound care and medication administration for two residents, resulting in deficiencies. For one resident with diabetes, peripheral venous insufficiency, and chronic leg ulcers, the facility did not transcribe a new wound care order for Medihoney to the Treatment Administration Record (TAR) after a physician consult indicated wound deterioration and ordered a change in treatment. As a result, the resident's right leg venous ulcer was not treated from October 30 to November 2, and the left leg wound treatment was inconsistently documented and not performed as recorded. Observations confirmed that wound dressings were loose and not dated appropriately, and wound measurements showed significant increases in size, indicating actual harm and further deterioration. Staff interviews revealed that wound treatments were documented as completed when they had not been performed, and the nurse responsible was unable to explain discrepancies between documentation and actual care provided. The Director of Nursing confirmed that wound treatments were missed for several days, and both wounds had increased in size with surrounding redness upon assessment. For another resident readmitted with a wound infection, the facility failed to administer ordered intravenous antibiotics (Ertapenem and Daptomycin) on two consecutive days due to lack of IV access. Although the physician was notified about the need for new IV access, there was no documentation that the physician was informed of the missed antibiotic doses. The resident ultimately received only six out of eight ordered doses. The DON confirmed the missed medication doses, indicating a failure to follow the physician's medication orders for wound infection treatment.