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Based on clinical record review and staff interviews it was determined the Registered Nurse failed to supervise and evaluate nursing care related to wound care and tube feedings for two (#2, #4) of four records reviewed. This practice does not ensure patient goals are met and may prolong patient stays.

Findings Include:

1. Patient #4's physician's order dated 6/5/10 at 1:56 p.m. instructed for wound care to the buttocks, right lower leg and right ankle to be done daily and as needed.

Review of the wound care documentation by the wound care nurses, nursing staff and physical therapy revealed the patient did not receive wound care as ordered for the buttocks on 6/9, 6/15, 6/17, 6/20, 6/21, 6/26, 6/30, 7/1, and 7/3 to 7/9/10, 15 out of 36 days. Wound care was not provided to the right leg/ankle on 6/6, 6/9, 6/15, 6/17, 6/20, 6/21, 6/27, 7/1, 7/3, 7/6, and 7/7/10, 11 out of 36 days. Wound care was not provided to the left leg on 6/28, 7/2, 7/3, 7/6, 7/8, and 7/10/10, 6 out of 17 days.

On 6/24/10 at 2:00 p.m. a physician order instructed for the left leg medial area to be cleansed with wound cleanser apply impregnated Vaseline 4x4 gauze and kerlix daily and as needed
Nursing documentation on 6/12/10 at 11:21 p.m. revealed a dressing change had been completed on the left medial leg. A review of the clinical record failed to reveal any further wound care or wound assessments until 6/24/10.

An interview with the Clinical Care Coordinator on 7/13/10 at approximately 12:30 p.m. confirmed the above findings.


2. Patient #2's nursing documentation dated 6/3/10 at 4:38 p.m. revealed a tube feeding was infusing via a intravenous pump. A review of the physician order revealed the patient was to have bolus tube feedings of 250 milliliters every 6 hours.

Review of the Medication Administration Record (MAR) revealed the tube feeding was documented as started at 12:00 noon on 6/3/10.

Interview with the Chief Clinical Officer and Director of Quality Management on 7/21/10 revealed the tube feeding was attached to the intravenous pump that was in the room for the intermittent antibiotic use, to infuse at 125 milliliters (ml) per hour for two hours. The interview revealed bolus tube feeding are to be given via syringe, not by pump over two hours. The interviews revealed the Registered Nurse (RN) checked with the another RN about the feeding and was informed that it could be placed on the pump to infuse.

Review of policy and procedure " Gastrostomy Tube Feeding " revised date 12/08 indicated the patency must first be check by flushing with 30 milliliters of water, aspirate to check stomach contents, and slowly administered the feeding by holding the tube 3-6 inches above the patient ' s stomach.