Failure to Complete Thorough Admission Skin Assessment and Timely Wound Treatments
Penalty
Summary
The facility failed to provide appropriate treatment and care according to orders and resident preferences by not thoroughly performing a skin assessment and not implementing timely wound treatments upon admission for one resident. The resident was admitted with diagnoses including surgical aftercare following digestive system surgery, hypertension, depression, and dysphagia, and had severely impaired cognition, requiring staff dependence for ADLs, transfers, and mobility. The admission skin assessment documented skin impairments on the right lower leg, right heel, and top of the right foot, but did not identify the type of skin impairment (such as skin tear, bruise, or pressure ulcer) and lacked descriptive details including color, drainage, and measurements. Physician orders and the treatment administration record showed that wound care treatments for the right lower leg, right heel, and top of the right foot were not ordered until three days after admission. The DON acknowledged awareness of the delay in implementing wound care treatments and stated that the admission nurse should have completed a thorough skin assessment and obtained treatment orders upon admission while awaiting a wound care consultation. The facility’s own Skin and Wound Guidelines required that wounds be evaluated and documented in the electronic medical record with specific elements, including wound type, location, measurements, wound bed tissue types, exudate, peri-wound condition, and treatment, and that treatment options be selected based on these characteristics, which was not done at the time of admission for this resident.
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