Failure to Notify Consulting Wound Specialist of Worsening Wound Condition
Penalty
Summary
The deficiency involves the facility’s failure to notify and consult the outside wound care clinic consulting specialist (WCCCS) regarding a resident’s deteriorating right lower extremity wound, despite clear signs of infection and decline. The resident was admitted with a chronic ulcer of the right ankle and varicose veins of the right lower extremity with ulcer, and initially had a wound vac in place per the WCCCS. After a follow-up visit, the wound vac was removed and an Unna boot was ordered. In the days that followed, clinical documentation showed increasing edema, redness, warmth, and an elevated white blood cell count, and the primary medical doctor (PMD) changed antibiotics and ordered specific wound care treatments while noting they had spoken with the WCCCS about the plan of care. However, there was no documentation that the facility actually consulted or updated the WCCCS about the wound’s deterioration during this period. Progress notes over the next several days documented the resident’s increasing pain, edema, warmth, drainage, erythema, foul-smelling yellowish drainage, saturated dressings, and surrounding redness and warmth suggestive of cellulitis and wound infection. A wound care nurse later documented increased ulceration, slough/necrosis, heavy serous and purulent drainage, bright yellow thick purulence expressed with light pressure, and a new purple fluid-filled lesion with peri-wound erythema and pain, with notification only to the wound care nurse practitioner. Interviews with the PMD and wound care nurse practitioner confirmed that they did not assume responsibility for contacting the outside consulting provider and that it was the facility’s responsibility to notify the WCCCS of wound deterioration. The clinical record lacked documentation of any wound treatments on the Treatment Administration Record for the month and contained no evidence that the WCCCS was consulted about the worsening wound until the resident’s subsequent follow-up visit, when the WCCCS sent the resident to the emergency room for a wound infection.
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