Failure to Implement and Obtain Physician Review of Wound Consultant Recommendations
Penalty
Summary
The facility failed to ensure that wound consultant recommendations were promptly reviewed with the attending physician and implemented for two residents. For one resident who was cognitively intact with morbid obesity, diabetes, incontinence of bowel and bladder, dependence for lower body care and bed mobility, and use of pressure-relieving devices, a wound consultant identified gluteal dermatitis and recommended a change in treatment due to difficulty keeping the area dry and the resident’s refusal of side-lying positions. The consultant recommended discontinuing silver sulfadiazine and initiating a regimen including cleansing with soap and water, drying, applying Nystatin powder, and covering with a nonwoven dry gauze pad twice daily and as needed. Although the facility received the wound consultant’s recommendations the same day they were made, the treatment was not initiated until two days later, and there was no documentation that the physician reviewed and accepted or declined the recommendations until that later date. For another resident who was cognitively impaired, required assistance with daily care and bed mobility, was frequently incontinent, and had a wound infection and a Stage 3 pressure ulcer with dementia, the wound consultant documented a left hip abscess and recommended a specific treatment regimen involving cleansing with wound cleanser, applying Bacitracin ointment, and securing with a dry dressing daily and as needed. A subsequent consultant note recommended continuing this same treatment. However, there was no documented evidence that the physician reviewed these wound consultant notes to agree or disagree with the recommendations, and the Treatment Administration Record did not show that the recommended treatment to the left hip abscess was completed. The DON, Nursing Home Administrator, and facility consultant confirmed that wound recommendations are received the same day but are often not reviewed with the physician until weekly rounds, and the DON confirmed that for both residents the wound care recommendations were not reviewed with the attending physician, resulting in the recommended wound care not being completed.
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