Failure to Provide Ordered Wound Care and Ensure Attendance at Wound Clinic Appointments
Penalty
Summary
The deficiency involves the facility’s failure to provide wound care as ordered and to ensure attendance at scheduled wound and infectious disease appointments for a resident with multiple comorbidities. The resident had diagnoses including heart failure, chronic kidney disease, type 2 diabetes, and a left diabetic foot ulcer, and was cognitively intact with a BIMS score of 15/15. The care plan identified increased risk for skin impairments and required monitoring and documentation of skin injuries, weekly wound measurements, and continuous use of a wound vac to the left heel. Physician orders included application of Iodoflex iodine pads to the left lateral heel ulcer every other day, with a subsequent order specifying Iodoflex application every two days and use of betadine gauze once Iodoflex was unavailable. Review of the Treatment Administration Records showed that ordered wound treatments were not completed on multiple scheduled dates in January and February. Specifically, the Iodoflex iodine pad treatment ordered every other day was not completed on several listed dates, and the Iodoflex external pad ordered every two days was also missed on multiple dates. The podiatry wound clinic provider reported concerns that the resident’s wound care needs were not being met, including missed wound clinic and infectious disease appointments, and difficulty obtaining wound care supplies. The provider stated she wanted to see the resident weekly, but the resident was a no-show for several wound and infectious disease appointments, and additional appointments were missed due to lack of transportation. Observations and interviews further showed inconsistencies in wound care delivery and documentation. The resident reported having wound clinic appointments every other week and stated that appointments were missed when the facility forgot to arrange transportation or lacked staff to drive the van. On observation, the resident’s left foot dressing was in place without a date, and when the resident asked an LPN about a dressing change, he was told it had already been done, although the TAR showed it had been signed off by a CMA who later admitted she had accidentally signed off all treatments for the resident. On a subsequent day, the same dressing was still in place, again without a date, and was removed and changed by an LPN/Assistant DON. Facility wound care procedure required staff to verify physician orders, review the care plan, and document refusals and physician notification if a resident refused treatment, but the report documents missed treatments and missed appointments without indication of resident refusal.
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