IDPH has cited and fined Aperion Care of Moline nursing home after a resident there developed a pressure sore on her heel but failed to notify the doctor to obtain proper treatment orders.
One of the basic facts of nursing home care is that doctors are not there on a 24/7 basis, so the nursing staff has to serve as the eyes and ears for the doctors as to what is happening with the residents who are under their care. That means that when the nursing staff must notify the resident’s doctor when there is a change in condition, when the resident experiences a nursing home fall, and so forth. This allows the doctor to decide whether to issue orders for the staff to carry out over the phone, to come into the nursing home himself, or to order the resident to be sent to the hospital.
One of the situations where physician notification is absolutely required is when a resident develops a new bed sore, also referred to as a pressure ulcer or pressure sore. One of the things that needs to be determined early on is what is the stage of the bed sore, as that will drive what kind of treatment the resident receives. Nurses don’t get to determine what kind of treatment should be ordered for a particular type of wound unless they are a wound care nurse, and even then, that is subject to the doctor issuing the order for care. Unfortunately for this resident, failing to notify the doctor and initiating treatment without orders is exactly what occurred to this resident.
The resident at issue had a Stage 4 deep tissue injury on her heel. The first time it was noted in the resident chart was when the nurse practitioner who treated wounds at this nursing home saw it. Before that, no nurse had documented in the resident’s chart the presence of this wound, its condition, the notification of the doctor, or the doctor’s orders for treatment of the bed sore – all things which would have occurred in well-run nursing homes.
On the day that the bed sore was discovered by the nurse practitioner, there was a foam dressing in place. A foam dressing was not appropriate for this type of wound, and there were no markings on the dressing itself to indicate who put the dressing on or when. The resident said that it had been put on a few days earlier, and there was enough drainage on the dressing to indicate that it had been at least a few days since it had been applied. Further, the resident was not getting a pressure-reliving boot, a crucial step to ensure that the wound healed.
Federal regulations require that nursing home residents receive care, treatment, and services necessary to promote healing, prevent infection, and prevent the development of new pressure sores. When nurses fail to notify the doctor and fail to obtain proper treatment orders, violation of these regulations is the almost certain result.
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