Failure to Provide and Accurately Document Ordered Skin Treatment
Penalty
Summary
The deficiency involves the facility’s failure to provide care and services according to accepted standards of clinical practice for a resident with intact cognition who was dependent for transfers and required assistance with bed mobility. The resident had diagnoses including cancer, hypertension, recent UTI, and chronic kidney disease, and was care planned as being at risk for altered skin integrity due to frequent urinary incontinence and need for bed mobility assistance. A health status note documented moisture breakdown on the left inner buttocks with specific measurements, and a physician order directed staff to apply barrier cream with cares every shift to promote healing; however, the order did not specify the location for application or the type of barrier cream to be used. The facility’s policy required active physician orders to be followed and carried out as written. On the morning in question, the resident reported that staff were in a hurry, that her bottom was hurting, and that no cream had been applied that morning, despite having ointment available in her bedside table and a treatment order in place. She stated not all staff had been using the cream. The Treatment Administration Record showed the barrier cream treatment as signed off as completed for that morning shift. A CMA reported he was told the barrier cream was applied with morning cares by two CNAs. One CNA stated she thought the other CNA applied a cream from a white tube but did not know what it was or where it came from, while the other CNA reported she did not assist with changing the resident’s brief that morning and did not apply any barrier cream. Later that day, an LPN measured the wound on the left buttocks and found it had increased in size with two small open areas, and applied Desitin ointment. The resident again verified she had not received any cream or treatment for the wound during the morning shift, indicating the ordered treatment was not provided as documented.
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