Failure to Implement and Complete Ordered Wound Treatments for Two Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide timely and ordered treatment for skin breakdown for two residents. One resident with diabetes with neuropathy, hypertension, and COPD was alert and oriented, required extensive assistance with ADLs, and used a mechanical lift and wheelchair. This resident had an existing treatment order for the right flank, but on a later date an RN documented a new area of impaired skin integrity on the left flank and noted that the wound care nurse had been notified. There was no documentation that the physician or responsible party were notified and no evidence that any treatment orders were obtained or implemented for the new left flank area. The resident reported having informed staff of discomfort at the left flank and that an RN had examined the area, but no dressing had been applied. When the wound care nurse later assessed the resident, a new red, 2 cm by 2 cm moisture-associated skin damage lesion was observed on the left flank, and it was confirmed that no treatment order existed for that area. The second resident had peripheral vascular disease and a chronic ulcer of the left lower leg and ankle and was alert, oriented, and largely independent with upper extremity ADLs but required more assistance for lower extremity care. This resident had physician orders for daily wound care to the left lower leg and later to the left foot, including cleansing, application of calcium alginate and gentamicin ointment, and appropriate dressings. Review of the treatment administration records showed multiple dates across three months when the ordered daily wound treatments were not completed. There was no documentation in the progress notes explaining why the wound care was missed on those dates. A family grievance had been filed alleging that the resident’s wound treatments were not being completed as ordered, and review of records confirmed that the treatments were not carried out on several specified days without documented justification.
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