Failure to Maintain Wound Dressings and Implement Leg Elevation for Residents With Venous Ulcers
Penalty
Summary
The facility failed to provide necessary care and treatment for residents with vascular ulcers as ordered and care-planned. For one resident with a right calf venous ulcer, surveyors observed that the right lower extremity had no dressing in place, with the leg discolored, reddened, and with two open areas. The wound nurse cleansed the skin and applied xeroform, gauze, and an elastic bandage at the time of observation, and stated she had not known the dressing had been removed and that if a dressing is removed it should be re-applied. The resident reported that the dressing had been removed during a shower the previous day and not replaced. The wound physician’s progress note and physician orders showed specific treatment orders for the right calf venous ulcer, including cleansing with normal saline and application of xeroform, gauze, absorbent pad, kerlix, and elastic bandage, and ace wraps to both lower extremities that may be removed for ADL care, indicating the dressing should have been in place after shower care. Another resident with bilateral venous ulcers and cellulitis of the lower limbs had significant lower extremity edema, pain, and burning sensations, and was observed sitting in a wheelchair with feet on the floor, wearing shoes without laces to accommodate swelling, and later in the activity room with gauze wraps and elastic bandages in place and visible swelling. The resident stated he did not have a chair to recline in to elevate his legs and expressed a desire for a reclining wheelchair to elevate them, explaining that when in bed he rests his feet on the bed in the lowest position. Nursing staff, including the RN, wound nurse, and DON, acknowledged the resident’s chronic pain and swelling, co-morbidities (including CHF and kidney disease), and the need for leg elevation, and the DON stated the resident did not have interventions in place to elevate his legs. The wound physician’s progress note documented venous ulcers on both legs with edema, warmth, erythema, drainage, and cellulitis, and the plan of care included leg elevation. The current care plan listed interventions such as compression therapy and leg elevation, but staff statements and observations showed that effective leg elevation interventions were not in place or implemented.
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