Failure to Follow Wound Care Orders and Implement Nutritional Recommendations
Penalty
Summary
The deficiency involves the facility’s failure to follow physician-ordered wound treatments and to implement Registered Dietician (RD) recommendations for wound healing for one resident with a pressure ulcer. The facility’s policies require prompt implementation of physician orders and nutritional interventions, including adequate protein, calories, fluids, and supplements for residents at risk of or with pressure ulcers. The resident had a right lateral foot pressure wound that progressed from Stage 3 to Stage 4, with multiple wound physician notes documenting ongoing nonviable tissue, necrosis, and repeated surgical excision of devitalized subcutaneous and muscle-level tissue over several weeks. Treatment Administration Records (TARs) for March and April showed missing documentation of the ordered wound care on multiple specific days, and the DON and Administrator confirmed there was no documentation that wound care was performed on those dates, acknowledging that if it was not documented, it was not done. The RD documented recommendations on two occasions for the resident to receive 30 ml liquid protein twice daily for 30 days to support wound healing. The resident’s current medical record contained no documentation that the facility addressed or implemented these RD recommendations on either date. Despite the ongoing severity of the Stage 4 pressure wound and repeated debridements, there was no evidence in the record that the recommended protein supplement was initiated. The wound physician stated that not following the RD’s recommendation for liquid protein and not following the physician-ordered wound treatments would most definitely contribute to the worsening of the resident’s wounds.
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