Failure to Follow Physician Orders for Wound Care and Timely Medication Administration
Penalty
Summary
The deficiency involves failure to provide treatment and care according to physician orders and resident needs for wound care and medication administration. For one resident with a left leg wound, the surveyor observed on two separate occasions that the wound dressing bore the same date, indicating it had not been changed for six shifts over a two-day period. The dressing was ordered by the primary physician to be changed daily on the day shift, and there was also an order for diabetic foot care checks requiring nursing staff to assess the resident’s feet and ankles. Documentation showed staff had signed off that they performed these checks, which would have required them to see the date on the dressing, yet the dressing remained unchanged. The DON acknowledged that the dressing should have been changed according to the physician’s order. The deficiency also includes failure to administer medications as ordered for another resident. Review of the medical record and MAR audit showed that multiple medications, including oxybutynin, midodrine, tizanidine, and Eliquis, were documented as given several hours after their scheduled administration times on two separate days. There was no documentation that any of these medications were held per physician order, refused by the resident, or delayed for a clinical reason, and no documentation that the physician was notified of the delayed administration. During interviews, the nurse involved and the DON were unable to provide any reason or supporting documentation explaining the late administration times recorded on the MAR.
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