The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

STEWARD SEBASTIAN RIVER MEDICAL CENTER 13695 US HWY 1 SEBASTIAN, FL 32978 Dec. 13, 2017
VIOLATION: NURSING CARE PLAN Tag No: A0396
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on clinical record review and staff interview, the facility's nursing staff failed to provide the necessary care and services related to nursing plan of care regarding wound care for 2 of 10 sampled patients (Patient #1 and #3) . The staff failed to provide evidence of contacting the physician to obtain wound care orders when noted changes in the wound had occurred.

The findings included:

1. Patient #1 was admitted to the facility on [DATE] with a diagnosis of abscess extending lymphitis. The patient was admitted to the facility after receiving emergency treatment of an I & D (Incision and drainage) of his abscess. In the ER, the wound was packed and dressed. Review of the admission orders for the patient did not contain physician orders regarding the care of the abscess. However, the physician prescribed for a referral to the Infectious Disease Physician for follow-up regarding the abscess wound. Review of the Nursing progress note documented that the patient's wound was experiencing excessive drainage saturating the original packing/dressing inserted in the emergency room . The nurses documented multiple times that the patient was noted to have drainage in the wound which would leak around and/or saturate the current dressing. Additionally, on 06/09/17 at 10:00 AM, the nurse documented "right arm dressing leaking, removed large amount of pus leaking from wound. Optiform packing removed from arm. Redressed and repacked with Optiform. Patient states he is upset due to not having dressing changed for many days and was not changed yesterday even after asking nurse about it." Later on the evening, the nurse noted that the upper extremity dressing was clean dry and intact. However, "Sponge placed over dressing for reinforcement."
Despite the nurses noting the wound was having copious amounts of serosanguinous and/or "pus" drainage, there was no apparent wound care orders and there is no evidence the nurses contacted the physician to obtain treatment orders with the noted changes in the wound.

An interview was conducted on 12/13/17 at 11:00 AM with the Nursing Director, who confirmed that the nurses noted that the patient's wound had an excess of drainage requiring a change in the dressing. She further confirmed that there is no evidence the nursing staff contacted the physician for wound care orders. Wound care orders were not written until 06/10/17, three days after the patient was admitted to the facility.

2. Patient #3 was admitted to the facility on [DATE] with diagnosis of leg leg cellulitis which cultured MRSA (Methicillin Resistant Staphylococcus Aureus). The nurses noted the wound area to be warm, red, edematous with a dressing in place. However, review of the physician orders failed to document a physician prescription for wound care.

An interview was conducted on 12/13/17 at approximately 1:00 PM with the Registered Nurse who confirmed that there was no evidence of wound care orders for the patient's wound on his left lower extremity.

The patient was discharged on [DATE] at 2:00 PM. The nurse noted that the patient's family was provided dressings for the wound. However, there is no indication what the dressings were and what was prescribed.