Failure to Provide Timely and Ordered Wound Care
Penalty
Summary
The deficiency involves the facility’s failure to provide wound care timely and in accordance with physician orders and the resident’s expectations. A cognitively intact resident with a significant surgical wound on the left lower extremity, admitted with an open wound, cellulitis, acute kidney failure, and type II diabetes, reported that their wound dressing was not changed as ordered. The resident stated that they had an order for wound care twice daily, in the morning and at bedtime, but on one evening the dressing was not changed at bedtime. When the resident asked the assigned nurse about changing the dressing, the nurse reportedly stated they were too busy, citing responsibility for 29 residents, and did not perform the treatment at that time. The resident reported that the wound dressing was not changed until several hours later, in the early morning. When the nurse eventually provided wound care, the treatment did not match the physician’s orders. The resident reported that the nurse used supplies that were unfamiliar to them and, when questioned, told the resident not to worry about what was being applied. Observation of the wound showed that the dressing did not fully cover the wound, leaving approximately one third exposed, and that a yellow padding was attached to the wound, which the resident and family member had not seen used before. Review of the clinical record showed specific orders to clean the left lower extremity wound with wound cleanser, pat dry, apply Opticell AG, ABD pads, wrap with kerlix, and secure with an Ace bandage every day shift and at bedtime, and as needed. The wound nurse indicated that the yellow pads were likely Xeroform, which was not part of the resident’s orders, and confirmed that the wound should have been fully covered per the orders. The administrator acknowledged awareness of the resident’s concerns and that treatment should be provided as ordered, and facility policy required that treatment be rendered in accordance with physician or other licensed health professional orders.
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