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Based on interview and record review, the hospital failed to ensure the RN [Registered Nurse] Supervisor evaluated and supervised the nursing care provided by LVN [Licensed Vocational Nurse] wound nurse. The wound nurse failed to ensure treatment orders were obtained for the treatment of red excoriated skin surrounding a new surgical site [ileostomy] for 1 of 3 patients reviewed [Patient #1].

Findings Included:

The physician discharge summary dated 04/28/10 reflected, "63 year old male admitted 04/14/10...adenocarcinoma of the left colon rectal area with recent low anterior sigmoid colon resection diverting loop ileostomy...debilitation, functional decline, candidemia..."

The nurses notes dated 04/15/10 timed at 12:37 reflected, "surgical incision open...RLQ [right lower quadrant] colostomy site...wound length 5 cm [centimeters] by 5.5 cm wide...full thickness skin loss involving damage or necrosis of subcutaneous tissue; may extend down to but not through underlying fascia; &/or mixed partial and full thickness and/or layers obscured by granulation tissue...exudate serosanguineous, thin, watery, pale red/pink..surrounding wound [peri wound/dressing] bright red and/or blanches to touch..."

The picture of the right lower quadrant ileostomy site dated 04/15/10 revealed, "red excoriated skin surrounding the stoma site." No further pictures were found.

On 08/26/10 at 11:00 AM, LVN #4 [Licensed Vocational Nurse], was interviewed. LVN #4 stated she was not the wound nurse for Patient #1. LVN #4 stated the wound nurse who took care of Patient #1 was no longer employed at the hospital. LVN #4 was asked by the surveyor to review the medical record, including the picture of Patient #1's ileostomy site taken 04/15/10. LVN #4 was asked to review the physician orders for ileostomy care for Patient #1's newly placed ileostomy. LVN #4 stated she could not find any treatment orders for the ileostomy. She reviewed the picture of the ileostomy. LVN #4 stated the red excoriated skin surrounding the stoma site required treatment. LVN #4 stated the nurse should have ordered layering adhesive powder and no sting spray to prevent further excoriation. She stated it was a new surgical site and the wound nurse should have monitored it.

On 08/26/10 at 2:00 PM the Administratro was interviewed. The Administrator was asked who supervises the LVN wound nurse? The Administrator stated the RN Supervisor does. The Administrator stated the hospital did not adequately supervise the wound nurse. The wound nurse should of obtained wound/treatment orders for the ileostomy site.

The policy dated 01/07 entitled, "Care Delivery" reflected, "clinical staff follow the Lippincott Manual of Nursing Practice for procedures...chapter 18 gastrointestinal disorders and complications...peristomal skin breakdown from exposure to fecal output, allergic reaction to products, or infections, such as candidiasis..."

The standards of Nursing Practice rule 217.11 reflected, under (D) (iii) physician...orders...(U) supervise nursing care provided by others who whom the nurse is professionally responsible.."