Failure to Cleanse Pressure Ulcers Before Applying Dakin’s-Soaked Dressings
Penalty
Summary
The deficiency involves the facility’s failure to provide wound care in accordance with physician orders and professional standards for a resident with pressure ulcers. The resident was admitted with diagnoses including dementia with mood disturbance, muscle weakness, and type 2 diabetes mellitus, and had an unstageable right ischial wound and an unstageable sacral wound. The care plan included an intervention to provide wound care as ordered by the physician. Active physician orders for both the right ischium and sacrum directed staff to cleanse the wounds with wound cleanser, pat dry, apply skin prep to the surrounding area, pack with Dakin’s soaked gauze, and cover with a dry dressing daily and as needed. During an observed wound care treatment, the LPN serving as the wound care nurse prepared Dakin’s half-strength solution and soaked gauze, stating she had been told by the wound provider not to clean the wound and expressing uncertainty about the correctness of this method. The LPN removed the old dressings, performed hand hygiene, donned clean gloves, and then packed both the sacral and right ischial wounds with Dakin’s soaked gauze without cleansing either wound beforehand, contrary to the physician’s orders. A 6x6 dressing was applied to the sacral wound and a 4x4 dressing to the right ischial wound. Interviews with another LPN and the DON confirmed that nurses are expected to follow provider orders and receive training from the wound nurse, while the DON referenced an unsigned statement suggesting Dakin’s solution did not require prior cleansing, which was not supported by the manufacturer’s article cited. The wound physician later clarified that nurses should follow his orders, that wounds should be cleansed at the time of treatment, and that Dakin’s solution could be used as a cleanser but should be used first to clean and then separately to pack the wound. Facility policy required all medications to be administered in accordance with orders.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.