Failure to Monitor and Treat Pressure Ulcers and Bruising Leading to Worsening Wounds
Penalty
Summary
The deficiency involves the facility’s failure to provide ongoing monitoring and treatment of pressure-related wounds and bruising for one resident, resulting in worsening wounds and the development of a new pressure ulcer. Upon admission, the resident reported having only an old, non-open sacral wound and no other wounds. An admission skin note documented extensive deep purple bruising to the left abdomen extending to the back shoulder blade, bruising to the right lower abdomen and left thigh from groin to knee, swelling of both arms, and a callous on the bottom of the right foot, while noting the sacral area as an old site that was not open. However, subsequent progress notes over multiple days and a weekly skin evaluation documented the resident’s skin as warm, dry, and intact with no wounds present, despite the earlier findings of extensive bruising and the known old sacral wound. A physician wound care note later documented the presence of an unstageable DTI of the right heel and an unstageable DTI of the sacrum, with corresponding treatment orders for skin prep and hydrocolloid dressings, and the care plan was revised to reflect risk for skin breakdown. The resident subsequently experienced abdominal pain, and hospital records showed admission for abdominal pain and a psoas muscle hematoma while on anticoagulant therapy. After readmission, the resident’s skin issues included a midline to the left upper arm, bruising to the left hip and abdomen, scattered bruising to the right forearm, an open sacral area, and a DTI to the right heel, with new wound care orders and care plan revisions for skin breakdown risk. The facility’s wound management policy states that in the absence of treatment orders the licensed nurse will notify the physician to obtain orders and that treatment effectiveness will be monitored through ongoing assessment, but the documentation and interviews show inconsistent and inadequate monitoring and documentation of the resident’s wounds and bruising, including failure to identify and document the heel wound at admission and failure to consistently monitor the extensive bruising and evolving pressure injuries.
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