Failure to Notify Physician and Representative of Change in Wound Status
Penalty
Summary
The deficiency involves the facility’s failure to ensure timely notification of a physician and resident representative when a resident’s wound status changed. The resident was admitted with multiple diagnoses including spinal stenosis, end-stage renal disease on dialysis, anemia, and type 2 diabetes, and had an infected back surgical wound and an infected finger awaiting amputation. The admission MDS showed the resident was cognitively intact and required varying levels of assistance with ADLs while using a wheelchair. The care plan included monitoring for complications related to end-stage renal disease and infection. Progress notes from the wound nurse documented an infected back surgical wound and, on a later date, a large amount of bloody/purulent drainage from the back wound, with the wound cleansed, packed with Iodoform gauze, and dressed per treatment orders. A subsequent physician order directed daily and PRN wound care to the lower back, including cleansing with normal saline, packing with Iodoform gauze, and covering with a dry dressing. On a later date, an RN documented purulent drainage from the back wound and that the dressing was changed per the physician’s order, but there was no documentation that the physician or family were notified of this change in the wound’s condition. The wound physician later stated he was unsure if he had been notified about pus or drainage from the thoracic surgery site and indicated he would not have changed treatment until he returned to the facility. The DON confirmed that the RN had not notified a physician or the family in the progress note and stated she would have expected at least notification of the on-call physician for any new development. The RN could not recall whether she had notified the physician or family and verified that no such notification was documented. Facility policy required informing the resident, consulting with the practitioner, and notifying the resident representative when there was a change in status, including significant changes in health status.
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