Failure to Follow Antibiotic Orders and Inadequate Wound Assessment
Penalty
Summary
Surveyors identified that one resident did not receive antibiotic therapy as ordered and another resident did not receive appropriate wound assessment. For the first resident, the admission MDS showed cognitive impairment, dependence on staff for daily care, cirrhosis of the liver, and enrollment in Hospice services. Physician orders dated early January directed that 500 mg of Cipro be administered every morning and at bedtime for 10 days to treat purulent drainage. Review of the MAR showed that the first two scheduled doses of Cipro were documented as not administered, and the medication was then given twice daily from the evening of the following day through the morning of the tenth day, resulting in only nine days of therapy. The Regional RN confirmed that the Cipro order should have been adjusted when the first two doses were missed so that the resident would still receive the antibiotic for the full 10 days as ordered, but this was not done. For the second resident, the admission MDS indicated that the resident was cognitively intact, occasionally bowel incontinent, and had no wounds. A care plan required weekly skin assessments and direction for the charge nurse to notify the wound nurse, physician, and family of any new skin areas. An initial skin assessment documented intact skin, and physician orders were obtained for zinc oxide to be applied to both buttocks and the coccyx every shift for prevention. A subsequent skin assessment documented that the resident’s skin was no longer intact, with treatment in place to the buttocks and coccyx, but there was no documented assessment of the change from intact to not intact skin and no evidence that the wound nurse was notified. A later skin assessment described a closed abrasion on the right buttock and blanchable redness on both buttocks, and the Regional RN confirmed there was no assessment of the area at the time the skin first changed.
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