Delay in Initiation of Wound Care Orders for Newly Admitted Resident
Penalty
Summary
A deficiency was identified when a resident was admitted with wounds and dressings on both feet, but did not have wound care orders initiated until nine days after admission. The resident had a complex medical history, including arthritis due to bacteria in the left ankle and foot, MRSA, diabetes mellitus, chronic kidney disease, congestive heart failure, pain, and edema. Upon admission, the resident's hospital discharge orders did not include wound care instructions, but the nursing assessment documented the presence of surgical incisions and dressings. The care plan noted the potential for skin breakdown and included interventions to administer treatments as ordered and monitor for effectiveness. Despite these documented needs, there was no evidence that wound care was provided or that orders were obtained until nine days after admission, when a physician finally ordered specific wound care procedures. Interviews with staff revealed that the admitting nurse is responsible for reviewing discharge orders, documenting wounds, and obtaining necessary wound care orders, but this process was not followed in this case. The Director of Nursing confirmed that the expectation is for the admitting nurse to follow up with the physician for wound care orders if they are not present at admission.