Failure to Timely Notify Wound Care Physician of Existing Pressure Ulcers
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident with multiple pressure ulcers received care consistent with professional standards by not timely notifying the Wound Care Physician (WCP) of the resident’s wounds. The resident was admitted with diagnoses including a thoracic vertebra wedge compression fracture, essential hypertension, and pressure-induced deep tissue damage of the left heel and other sites. On admission, the resident’s assessment documented multiple pressure ulcers on the right deltoid, right lateral forearm, right lateral knee, and right upper and lower hip, and the admission orders included daily betadine and dry dressings to several of these areas. The facility’s policy required that practitioners assist in identifying ulcer type, characteristics, complications, and contributing factors. Subsequent documentation showed that the resident’s H&P identified pressure ulcers on the right shoulder, right rib area, right upper and lower hip, right elbow, and right lateral leg, and the MDS indicated the resident had severely impaired cognitive skills for daily decisions, was dependent on staff for ADLs such as toileting, showering, and dressing, and was at risk for pressure ulcers with four unstageable pressure ulcers and one DTI present on admission. Interdisciplinary Wound Management Updates on two separate dates documented “wound consult,” indicating that a wound consult was needed. However, interviews revealed that the Treatment Nurse was responsible for wound care consult orders and that the practice was to notify the WCP of wounds only when the WCP visited weekly, not on the day of admission. The WCP visited the facility on two occasions after the resident’s admission but was not informed of the resident’s pressure ulcers on those visits. The DON confirmed that the WCP stated no one had informed him of the resident’s pressure ulcers during his earlier visit. The Treatment Nurse stated that the WCP was not informed on the first two weekly visits after admission and that the WCP did not see the resident for 12 days after admission. When the WCP finally evaluated the resident, multiple pressure ulcers were assessed and a surgical debridement of the right inferior hip pressure ulcer was performed, with measurements documented before and after debridement. The DON stated that surgical debridement removes dead skin cells for proper wound healing and that a delay in debridement could affect and slow down the resident’s wound healing.
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