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Based on record review, and interview, the facility failed to provide documented evidence that staff evaluated the status of a patient ' s surgical wound;
Failed to show evidence that daily dressing changes ordered by the physician for a patient was done as ordered .
Citing one of four sampled current patients and one patient in a complaint TX00128323.(Patient # 1).


Findings:
Patient # 1
During a complaint investigation TX00128323 there was allegation that Patient # 1 developed infection in her surgical wound, requiring wound debridement at an Acute Care Hospital.

Review of the patient's clinical record revealed the following information:

Nurses notes dated 9/15/09 documented the patient was admitted to the facility with history of recent back surgery. On admission the surgical wound had sutures the wound was clean, dressing dry and intact no drainage or odor.

Nurses notes dated 9/16/09 documented the surgical wound had moderate drainage, sutures in place, the wound was cleaned and covered with abdominal pads.(ABD dressing).

Physician's orders dated 9/16/09 requested to clean wound with wound cleanse and apply dry dressing daily.

Review of Nurses notes dated 9/17/09 -9/20/09 documented incision with sutures dressing dry and intact. There was no documentation describing healing , color or smell of the wound.

Review of physician's progress notes dated 9/19/09 documented Patient # 1 complained of mild lower back spasm, the incisional wound had minimal drainage, sutures in place, no prurelent discharge.

There was a physician's order dated 9/19/09 to clean wound with wound cleanse and apply Xeroform dressing daily.

Review of Nurses notes dated 9/21/09 documented "wound with small amount of sero-sanguineous drainage no malodor. Patient had loose bowel movement Tech assisted patient with cleaning up after bowel movement".

Review of physician's progress notes dated 9/21/09 documented the spinal incision wound dehiscence (opened).

On 9/22/09 the physician ordered wound culture and sensitivity test.

Nurses notes dated 9/22/09-9/25/09 documented that the patient's surgical wound had sutures there was no drainage or malodor.

Review of preliminary and final laboratory report received 9/26/09 for wound culture done on 9/22/09 documented Eschericia Coli ( E. Coli) identified heavy growth.

Review of discharge summary dated 10/28/09 revealed discharge diagnosis of wound infection.

During the patient's stay at the Rehab hospital the nurses did not describe the wound or evaluate the status of the wound. There was no nursing documentation that the surgical wound had opened up. No indication that the might be infected.

Further review of nursing notes revealed nurses did not develop a nursing plan of care that identified the patient's wound care needs.

Review of discharge Summary from the Acute Care Hospital where Patient # 1 was admitted dated 10/2/09 revealed the following information:

Patient # 1 was seen in the physician ' s office on 9/25/09 with "wound dehiscence and foul smelling wound. Thus she was admitted to the hospital on 9/25/09 for irrigation and debridement of the wound".
Surgical procedure report from the acute care hospital dated 9/25/09 documented the findings:
"The patient had an obvious wound dehiscence. She had a lot of necrosis at the wound edges that in places extended out beyond a centimeter. During the procedure the skin was widely excised .
The nurses at the Rehab hospital did not evaluate the condition of the of the patient's wound and did not know the patient's wound was infected.
During an interview on 5/21/10 at 10 am on Station # A with Staff # 51 Chief Nursing Officer, she stated she was told that Patient # 1 went out on a therapeutic pass for a physician ' s appointment and was admitted the same day to an acute care hospital for wound debridement.
According to Staff # 51 there were some areas of poor wound care documentation and new assessment protocols would be implemented.

Based on record review, and interview, the facility failed to show evidence that abnormal wound culture report was tracked to identify source of the infection and to implement preventative measures when a wound culture for a patient who was positive for Escherichia Coli (E Coli).Citing one of four sampled current patients and one patient in a complaint TX00128323.(Patient # 1).


Findings:

Patient # 1

During a complaint investigation TX00128323 there was allegation that Patient # 1 developed infection in her surgical wound, requiring wound debridement at an Acute Care Hospital.

Review of the patient's clinical record revealed the following information:

Nurses notes dated 9/15/09 documented the patient was admitted to the facility with history of recent back surgery. On admission the surgical wound had sutures the wound was clean, dressing dry and intact no drainage or odor.

Nurses notes dated 9/16/09 documented the surgical wound had moderate drainage, sutures in place, the wound was cleaned and covered with abdominal pads.

Physician's orders dated 9/16/09 requested to clean wound with wound cleanse and apply dry dressing daily.

Nurses notes dated 9/17/09 -9/20/09 documented incision with sutures dressing dry and intact.

Physician's progress notes dated 9/19/09 documented patient # 1 complained of mild lower back spasm, incisional wound with minimal drainage, sutures in place no purulent discharge.

There was a physician's order dated 9/19/09 to clean wound with wound cleanse and apply Xeroform dressing daily.

Nurses notes dated 9/21/09 documented "wound with small amount of sero-sanguenous drainage no malodor (bad smelling).

patient had loose bowel movement, Tech assisted patient with cleaning up after bowel movement".

On 9/21/09 the physician's progress notes documented the spinal incision wound dehiscence (opened).

On 9/22/09 the physician ordered wound culture and sensitivity(C/S) test.

Nurses notes dated 9/22/09-9/25/09 documented that the patient's surgical wound had sutures there was no drainage or mal odor.

There were notes dated 9/24/09 for the patient to see the surgeon due to wound dehiscence .
Review of preliminary and final laboratory report received 9/26/09 for wound culture done on 9/22/09 documented Eschericia Coli ( E. Coli) identified heavy growth.

Review of discharge summary dated 10/28/09 revealed discharge diagnosis of wound infection.

Review of infection control report revealed there was no investigation conducted following receipt of the laboratory report.

During an interview on 5/21/10 at 10am with staff # 51 Director of Nursing she stated there was no excuse however around that time the facility was without an infection control manager to conduct the necessary follow up. The facility had since employed an infection control manager.

Based on record review and interview the facility failed to show evidence that data was collected and analyzed for a patient who developed E. Coli in her wound which resulted in Acute Care Admission for wound debridement,irrigation and intra venous antibiotic therapy. Citing one of four sampled current patients and one patient in a complaint TX00128323.(Patient # 1).

Findings:

Patient # 1

Review of nurses notes dated 9/15/09 documented Patient # 1 was admitted to the facility with history of recent back surgery. On admission the surgical wound had sutures the wound was clean, dressing dry and intact no drainage or odor.

Review of physician's progress notes dated 9/21/09 revealed documentation that the spinal incision wound dehiscence (opened).

On 9/22/09 the physician ordered wound culture and sensitivity(C/S) test.

There were physician's notes dated 9/24/09 for the patient to see the surgeon due to wound dehiscence .
Review of laboratory report dated 9/24/09 of a wound culture that was collected 9/22/09 for Patient #1 the results revealed the wound had Escherichia coli (E.coli) bacteria . The patient ' s WBC( White Blood Cell Count) was documented as 11.2 (high) normal rate is 4.3-10.8
There were notes dated 9/24/09 for the patient to see the surgeon due to wound dehiscence .
Review of Nurses notes dated 9/22/09-9/25/09 documented that the patient's surgical wound had sutures there was no drainage or malodor(bad smelling order).

Review of Physician's notes from the Acute Care Hospital revealed the following information:
Patient # 1 was seen in the physician ' s office on 9/25/09 with "wound dehiscence and foul smelling wound. Thus she was admitted to the hospital on 9/25/09 for irrigation and debridement of the wound".
Surgical procedure report from the acute care hospital dated 9/25/09 documented the findings:
"The patient had an obvious wound dehiscence. She had a lot of necrosis at the wound edges that in places extended out beyond a centimeter. During the procedure the skin was widely excised .

During an interview on 5/21/10 at 10:35 am with staff # 51 Chief Nursing Officer, she stated she knew the patient went for an appointment with her surgeon and was admitted for wound debridement. According to the Staff the patient's medical record was never reviewed for quality issues.
During an interview on 5/21/10 at 10:55am with staff # 50 Quality Director she stated she was new to the facility but had identify some quality issues and was in the process of implementing new protocols to deal with problems further stated issues with Patient # 1 was not identified but the record would be reviewed.