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It was determined based on interview and record review the hospital failed to ensure physician order's were obtained for a cleansing agent, amount of silversorb to apply and whether Patient #1's wound be covered or left open to air for the [peri rectal, right labia and vaginal wounds] for 1 of 3 patients reviewed [Patient #1].

Findings Included:

Patient #1's History and Physical dated 06/25/10 reflected, "Multiple wounds including vagina...Herpes Simplex, recent history of Glioblastoma status post surgery and Chemotherapy, Hypertension, Left Side Weakness, Chronic Pain, History of Urinary Tract Infection and Anxiety..."

The physician's orders dated 06/26/10 timed at 12:00 PM reflected, "Silversorb Gel to peri wounds three times a day and as needed. When cleaning, medicate prior to cleaning...sage barrier wipes to clean...lidocaine 2% [percent] jelly to peri rectal and labia ulcers for pain apply topically prn [as needed] with cleaning stool, apply after cleaning..."

The 06/26/10 to 06/27/10 wound documentation record reflected, "Wound #1, peri-rectal lesion....cleanse area with normal saline, medicate prior, apply lidocaine to numb then silversorb, leave thick layer, open no drsg [dressing]...wound #2, right labia...cleanse with normal saline do not rub, apply lidocaine to numb then silversorb, apply after each stool and twice daily" Note the above physician order did not indicate wound cleansing agent, amount of silversorb to apply and whether the wounds were to be covered or not.

The physician's orders dated 07/7/10 timed at 08:00 reflected, "Clarification wound care for labia and peri rectal wounds, apply topical Zovirax twice daily, may use lidocaine jelly for topical pain relief twice daily, discontinue all other ointments/creams..."

The 07/7/10 and 07/8/10 wound documentation record reflected, "Wound #1, peri-rectal cleansed with wound cleanser, pre-medicate, pat dry and apply Zovirax ointment to wound, then vaseline gauze, keep off back...Wound #2, right labia cleanse with wound cleanser, pat dry, apply Zovirax ointment twice daily and after each stooling...Wound #3 vaginal, cleanse with wound cleanser, pat dry apply Zovirax ointment, cover with vaseline gauze" Note the above physician order did not indicate the wound cleansing agent and covering the vaginal wound with vaseline gauze.

On 09/29/10 at approximately 3:30 PM, RN [Registered Nurse] #11 was interviewed. RN #11 was asked by the surveyor to review Patient #1's medical record which included, physician's orders and wound care records. RN #11 stated she forgot to get the necessary orders for wound care including the cleansing agent.

The policy entitled, "Wound Cleansing" dated 05/21/07 reflected, "the policy is to clean wound in an effective manner as to minimize chemical and mechanical trauma to the wound...use a noncytonic solution to cleanse the wound surface...normal saline, sterile water or wound cleanser is an acceptable wound cleanser for wounds that are granulating or in the proliferative phase as it will not harm tissue...irrigate on "stream" if using wound cleanser..."