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Based on clinical record review and interview, it was determined the Facility failed to follow their policy and procedure in providing care for four (#7, #8, #11 and #20) of four (#7, #8, #11 and #20) patients with wounds. Failure to follow policy and procedure did not allow the four affected patients to receive care as ordered by the physician or per protocol. Findings follow:

A. Review of the Skin Integrity, Care of the Patient With or At Risk for Impairment Policy and Procedure received from the Regulatory Officer at 0915 on 05/29/14 revealed the following under I. Assessment/Ongoing Evaluation: B.ii. If there are not orders for pressure ulcer care, obtain an order to: clean the wound with normal saline, apply a normal saline moistened gauze dressing daily until the wound can be evaluated by the physician or Wound, Ostomy Continence Nurse and further orders obtained.
B. Per interview with the Executive Director of Nursing at 1055 on 05/29/14 the skin care protocol should have been instituted if there were a pressure ulcer and no physician orders.
C. Review of Patient #7's clinical record revealed wet to dry dressing changes were performed at 0700 and 2200 on 05/28/14 and 0700 on 05/29/14 without physician's orders. The findings were verified by Registered Nurse (RN) #1 at 1500 on 05/29/14.
D. Review of Patient #8's clinical record revealed orders authored by Physician #2 at 1959 on 05/27/14 for Calmoseptine cream TID (three times a day) and Xenaderm topical BID (two times a day) to wounds. Review of nursing notes from 05/27/14 through 05/28/14 revealed no application of medication to wounds. The findings were verified by RN #1 at 1500 on 05/29/14.
E. Review of Patient #11's nursing assessment revealed a Stage 2 pressure ulcer on the sacrum. Patient #11 was admitted on 05/27/14 and review of the clinical record revealed no orders for wound care until 05/29/14 and no wound care performed until 05/29/14. The findings were verified by RN #1 at 1510 on 05/29/14.
F. Review of Patient #20's clinical record revealed no physician's orders for wound care. Review of the nursing notes revealed a dressing change was performed on 02/18/14. These findings were verified by the Physician Educator for Clinical Information at 1022 on 05/30/14.