LPN Performed Wound Assessments Without Proper Competency or Oversight
Penalty
Summary
A Licensed Practical Nurse (LPN), identified as Staff E, was responsible for wound care assessments and documentation for a resident with a Stage 4 pressure injury. The facility's policy required that a licensed nurse assess and evaluate all wounds at least weekly, including detailed measurements, staging, and descriptions of the wound and surrounding tissue. However, review of wound care documentation revealed that Staff E completed multiple wound evaluations without co-signature or oversight from a Registered Nurse (RN) or Wound Care Specialist, as required for comprehensive wound assessments. Interviews with Staff E revealed that they did not perform full wound assessments or staging, but rather followed previous wound care provider assessments and documented based on whether the wound appeared unchanged. Staff E admitted to not being wound care certified and was unsure if wound assessment was within their scope of practice as an LPN. The Director of Nursing (DON) confirmed that Staff E was not wound care certified and acknowledged that wound assessment is not within the LPN's scope of practice, and that the evaluations completed by Staff E were classified as full assessments in the facility's software system. Further investigation found that there was no competency skills checklist on file for Staff E, despite their role as the facility's wound nurse. Human Resources was unable to locate any documentation of completed competency assessments for Staff E, who had been employed since July 2023. The lack of appropriate competency verification and oversight placed residents at risk for inaccurate wound assessments and unmet care needs.