Caring Heart Rehabilitation And Nursing Home (March 25Th 2014)

Physician’s orders related to wound care for two of 30 residents reviewed was not followed at the nursing home. Findings included the following: Review of the clinical record for Resident R234 revealed that the resident was admitted to the facility on an undisclosed date. Further review of clinical documentation Pressure Ulcer Evaluation, dated February 6, 2014 through March 20, 2014, reflected the presence of two stage IV pressure ulcers on the buttocks and one excoriated area on the resident’s left posterior thigh. Physician orders dated March 2014, indicated that the resident was to have a wound to the left posterior thigh cleansed with NSS, Santyl, applied to the wound bed and then the wound was to be covered with a clean dry dressing. Observation of wound treatment to Resident R234 on March 24, 2014 at 11:00 a.m. with Employee E4, licensed nurse revealed that after cleansing the left posterior thigh wound with normal saline, applying Santyl ointment to the wound bed, the employee would then proceed to pack the wound bed with saline wetted gauze and then covered the wound with a clean dry dressing. Interview with Employee E4, immediately following the wound treatment confirmed the employee was aware that the current physician order did not call for the left posterior thigh wound to be packed. Review of Resident’s R206’s clinical record revealed that he was readmitted to the facility on an undisclosed date with an unspecified diagnosis. Physician’s orders, dated September 26, 2013, and continued monthly, found the areas of skin breakdown of Resident R206’s left ischium and under the scrotal sac be cleansed, patted dry, and calcium alginate applied. Observation of wound treatment to Resident R206 on March 21, 2014 at 11:00 a.m. licensed nurse Employee E3 to clean and dry the wounds, apply calcium alginate dressings on the ischial breakdown, then apply a calcium alginate dressing with antibacterial silver to the wound bed under the scrotal sac. Interview with licensed nurse employee E3 on March 21, 2014 at 11:30 a.m. confirmed that the dressing with antibacterial silver had been applied without a physician’s order. Review of Resident 206’s clinical record revealed physician’s orders dated October 25, 2013 and continued monthly, to cleanse the resident’s right medial ankle, pat dry, then apply skin prep to the periwound area and Santyl to the wound bed. Observation of wound treatment at 10:45 a.m. on March 21, 2014 found licensed nurse Employee E3 apply skin prep to the periwound and wound bed. Interview with licensed nurse Employee E3 on March 21, 2014 at 11:30 a.m. confirmed that she did not apply the physician-ordered Santyl to the ankle wound bed.

Based on observation, review of clinical records, and facility policies and procedures and interviews with staff, it was determined that the nursing home failed to ensure that wound treatments were completed in accordance with proper infection control practices for three of 30 residents reviewed.