Failure to Educate Resident on Consequences of Refusing Pressure Ulcer Care
Penalty
Summary
A resident with multiple diagnoses, including metabolic encephalopathy, osteoarthritis, hydronephrosis, and acute osteomyelitis, developed a facility-acquired deep tissue injury (DTIP) on the coccyx, which later progressed to a stage 3 pressure ulcer and subsequently to an unstageable pressure injury with significant necrotic tissue. The resident was cognitively intact and required varying levels of assistance with activities of daily living, including being dependent for toileting hygiene and lower body dressing. The resident refused certain interventions, such as repositioning and the use of a low air loss mattress, which were recommended to prevent further wound decline. Despite these refusals, there was no documentation that the resident was educated about the need for these interventions or the consequences of refusing them. The wound care nurse was unable to provide evidence of education regarding the risks associated with refusal of care, and the risk notification was only reviewed with the resident's power of attorney, not the resident themselves. The care plan initially did not address the resident's refusals regarding repositioning until several months after the pressure injury was identified. Wound assessments documented the progression and worsening of the wound, including increased size and necrosis, but did not indicate that education about the consequences of refusal was provided. The facility's policy required ongoing evaluation of the plan of care and reassessment if the patient was not responding to treatment, but there was no evidence that these procedures were followed in relation to educating the resident about the risks of refusing recommended wound care interventions.