Failure to Follow Wound Care and Compression Stocking Orders
Penalty
Summary
The deficiency involves the facility’s failure to provide wound care and compression therapy as ordered for two residents with lower extremity wounds. One cognitively intact resident with heart failure, hip fracture, diabetes, and kidney disease had non‑pressure wounds on the left anterior and lateral leg, caused by being struck with something. The resident’s care plan did not address wound care, despite active wound treatment orders specifying cleansing with wound cleanser or normal saline, application of skin prep, xeroform gauze, collagen powder, gauze, and Kerlix wrap secured with tape. Documentation showed wound treatments were not completed on certain ordered days. Observations revealed dressings dated several days earlier that were saturated with serous drainage, with surrounding skin macerated, and the resident reported having to change a wet sock due to drainage. During wound care observations, an LPN removed a saturated dressing that had been in place for multiple days and applied only a Mepilex dressing, omitting the ordered skin prep, xeroform, collagen powder, gauze, and Kerlix. The LPN also did not apply the resident’s ordered XXL knee‑high compression stockings, despite an active order for application in the morning and removal in the evening. On multiple subsequent observations, the resident continued to be without compression stockings, and the left leg dressing remained saturated with serous drainage and dated several days prior. The ADON later performed the wound treatment and stated the facility did not have collagen powder available, and she completed the dressing change without it. Facility leadership, including the ADON and DON, stated that nurses were responsible for completing wound treatments as ordered, ordering needed supplies, and accurately documenting treatment completion. A second resident, admitted with diagnoses including CHF, pneumonia, glaucoma, and diabetes, had no baseline care plan to direct staff on care needs. An order was in place to cleanse a skin tear on the left lower leg with normal saline, apply xeroform, and a dry dressing daily and PRN. From the date the order was initiated through several subsequent days, staff did not document completion of the ordered treatment. The resident reported having a wound on the left leg/ankle, and a CNA reported that the wound occurred when the resident’s leg became caught during a transfer with a PT. Observation later showed the dressing on the left leg still dated from the initial treatment date, indicating that ordered daily and PRN wound care had not been performed or documented during that period. The Regional Nurse Consultant confirmed that nurses were responsible for documenting completion of wound treatments and following physician orders.
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