Failure to Care Plan for Post-Operative Foot Cellulitis and Antibiotic Therapy
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement a person-centered, comprehensive care plan for a resident who developed cellulitis of a right foot surgical wound and was started on antibiotics. The resident had undergone right foot surgery involving arthrodesis of the 2nd, 3rd, and 4th toes and had orders for the sterile surgical bandages to be kept clean and dry with no bandage change needed, and to notify the physician’s office if there was a problem with the bandage. The resident was cognitively intact per a BIMS score of 15/15 and reported that about a week and a half after surgery, a CNA placed a clear plastic trash bag over the right foot and secured it with tape for a shower, but the tape slid down, allowing water to enter the bag and soak the dressing. The resident stated that after the shower there were about three inches of water in the bag, the dressing was wet, and the nurses did not change or reinforce the wet dressing. The resident reported that the wet dressing remained in place for four to five days until a post-operative visit with the podiatrist. At that visit, the podiatrist documented that the dressings were soiled and malodorous, with some wound dehiscence proximally to the 2nd toe incision, erythema and increased warmth to the dorsal midfoot, and skin maceration. The podiatrist assessed cellulitis and prescribed oral antibiotics. The facility’s Order Summary Report reflected an order for Amoxicillin-Pot Clavulanate 875-125 mg to be given every 12 hours for 14 days for bacterial infection, with the DON and treatment nurse confirming that the antibiotics were started after the post-operative appointment for a bacterial infection/cellulitis of the surgical wound. Despite the new diagnosis of cellulitis and the initiation of antibiotic therapy, interviews and record reviews with the LVN, treatment nurse, and DON showed there was no care plan addressing the resident’s foot infection, cellulitis, or antibiotic use. Both the LVN and treatment nurse were unable to locate any care plan related to the infection or antibiotic treatment, and the DON confirmed that no care plan had been entered for cellulitis or antibiotic use, despite the facility’s policy requiring comprehensive, person-centered care plans with measurable objectives, time frames, and interventions that reflect current standards of practice and are revised as residents’ conditions change. The surveyors concluded that the facility failed to ensure a person-centered comprehensive care plan was implemented for this resident, which had the potential for the resident’s needs to go unmet.
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