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SELECT SPECIALTY HOSPITAL MEMPHIS
STAFFING AND DELIVERY OF CARE
Tag No.: A0392
Intakes: TN00029587
Based on medical record review and interview, it was determined the facility failed to ensure nursing staff performed wound care in accordance with physician's orders for 2 of 5 (Patients #2 and 4) sampled patients with wound care orders.
The findings included:
1. Medical record review for Patient #2 revealed the patient was admitted to the facility 3/20/12. The face sheet for this patient documented, "Chief complaint/ Admitting Diagnoses" as "Non Healing Wounds."
Physician's orders for Patient #2's wound care dated 3/21/12 documented, "...(R) [right] Gluteal, Apply Tegaderm Absorbent Clear Acrylic dressing or Hydrocolloid dressing standard. Change every 3-5 days & [and] PRN [as needed]..."
Review of the "WOUND DOCUMENTATION" form documented wound care for Right Gluteal was performed 3/21/12, 3/28/12 and 4/2/12. There was 7 days between wound care performed on 3/21 and 3/28. The wound care was not performed every 3-5 days as ordered.
During an interview on 4/12/12 at 2:40 PM, the Director of Quality Management verified wound care for Patient #2 was not performed every 3-5 days as ordered.
2. Medical record review for Patient #4 revealed the patient was admitted to the facility 4/4/12. The face sheet for this patient documented, "Chief Complaint/ Admitting Diagnosis" was "Non Healing Wound."
Physician's orders for Patient #4 documented, "4/5/12, Wound Care Orders... (L) [left] Lower Leg, Fill c [with] Hydrofera Blue, Cover c 4 x [by] 4 gauze, ABD [abdominal pad] and wrap c Kerlix roll. Secure c medipore tape. [Triangle symbol for change] dsg [dressing] 3 times per wk [week] or PRN [as needed] for dressing saturation. Sacral ulcer, Apply Cavilon No Sting Barrier Film to periwound skin. Let dry. Mesalt to cover entire wound bed. Cover c gauze/ABD pads and secure c medipore tape. [Triangle symbol for change] dsg 3 times per wk & [and] PRN..."
Review of Patient #4's Wound Documentation record for the (L) Lower Leg wound revealed wound care was performed and the dressing changed 4/5/12, 4/9/12 and 4/12/12. The wound care was not performed 3 times a week as ordered.