Failure to Ensure Nurse Competency in Wound Care Procedures
Penalty
Summary
The facility failed to ensure that licensed nurses possessed and demonstrated the necessary competencies and skills to provide proper wound care for two residents. Specifically, the Assistant Director of Nursing (ADON) did not fully cover a resident's wound bed with calcium alginate dressing as ordered by the physician, and on two separate occasions, did not date or initial wound dressings after providing care to two different residents. These actions were observed during wound care procedures and were not in accordance with the facility's wound care policy, which requires dressings to be labeled with the date, time, and staff initials. One resident involved was a female with a history of enterocolitis due to clostridium difficile, diabetes mellitus, and peripheral vascular disease, who had a diabetic foot ulcer requiring daily wound care. During wound care, the ADON failed to fully cover the wound with the prescribed dressing and did not label the dressing on a subsequent day. The second resident was a male with diagnoses including unsteadiness, malnutrition, colostomy status, and a stage four pressure ulcer. The ADON also failed to date and initial the dressing after wound care for this resident. Interviews with facility staff revealed a lack of clarity regarding responsibility for staff competency assessments and uncertainty about whether wound care competencies were included in staff checks. The ADON acknowledged not realizing the errors at the time and recognized that not labeling dressings could result in confusion for subsequent staff. The facility's wound care policy and competency documentation indicated requirements for proper wound care procedures, including labeling of dressings, which were not followed during the observed incidents.