Failure to Timely Implement and Discontinue Wound Care per Consultant Recommendations
Penalty
Summary
The deficiency involves the facility’s failure to provide pressure ulcer care in accordance with professional standards and its own policy requiring evidence-based interventions as ordered by a provider and coordination with the resident’s medical provider when using a consulting wound care provider. For one resident with traumatic ischemia of muscle and pressure ulcers, admission assessments showed the resident was cognitively intact and required staff assistance for daily care. Physician orders directed specific wound care to the right buttock, right sacrum, right lateral and proximal areas using wound cleanser, hydrogel, and dry dressings, and to the left sacrum using wound cleanser, Bacitracin ointment, and dry dressings, to be changed daily and as needed. Subsequent wound consultant notes documented that the right sacral pressure ulcer had resolved with a recommendation to discontinue treatment, and later that the left sacral pressure ulcer had also resolved with a recommendation to discontinue treatment. However, there was no documented evidence that the attending physician reviewed these wound consultant recommendations to agree or disagree. The Treatment Administration Record showed that staff continued to apply hydrogel to the right sacrum and Bacitracin to the left sacrum through early March, despite the consultant’s recommendations to discontinue treatment and the lack of documented physician review or updated orders. For another resident who was cognitively impaired, required substantial assistance with bed mobility, was frequently incontinent of bowel and bladder, and had dementia, a wound consultant documented an unstageable, rapidly progressing left sacral pressure ulcer with eschar and slight induration. The consultant recommended a change in treatment, including cleansing with wound cleanser, applying skin prep to the peri-wound, applying Bacitracin to the wound base, and securing with a bordered dressing daily and as needed. The Treatment Administration Record showed that this recommended treatment was not initiated until several days later, and there was no documented evidence that the physician reviewed and accepted or declined the recommendations until that time. Facility leadership confirmed that wound care recommendations are received the same day but are often not reviewed with the physician until weekly rounds, and that there was no documentation of timely physician review or initiation of the recommended treatment for this resident’s worsening pressure ulcer.
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