IDPH has cited and fined Arcadia Care of Morris nursing home after a resident there developed an infection of a surgical wound for a hip fracture, requiring IV antibiotics and a surgical debridement.
The resident at issue was admitted to the nursing home for post-operative care after suffering a broken hip in a fall. There was a surgical wound incision that had been closed with staples, and the resident was supposed to be seen in the surgeon’s office for removal of the staples in 1-2 weeks.
That didn’t happen – because the nursing home staff seems to have failed to recognize that there was a surgical wound, despite the fact the resident was being admitted for post-operative care.
When a resident is admitted to a nursing home from a hospital, there are a number of steps that must be taken. One of these is to take the discharge instructions and orders and have them added to the resident’s chart with the resident’s attending physician giving orders for care. This helps assure continuity of care – that the resident continues to get the care in the nursing home that the doctors in the hospital wanted them to get. The order is a head-to-toe inspection of the resident’s skin. Part of this is to ensure that the resident is not arriving at the nursing home with bed sores that the nursing home might otherwise be blamed for, but also to ensure that if there is some defect in the skin, that proper orders are obtained for caring for that.
When this resident was admitted to the nursing home, that comprehensive skin assessment was apparently not done, as there was no documentation of that. There were also no orders for wound care obtained from the resident’s physician. The resident’s 1-2 week follow up appointment was not set. The resident care plan, which is supposed to address all of the risks to the health and well-being of the resident, did not address wound care. A single note, done a month after admission by the wound care nurse, documents that there was no injury to the skin.
Two days after the note was generated by the wound care nurse, and more than five weeks after the surgery, the resident was brought to the orthopaedic surgeon’s office. He removed the staples and sent the resident to the hospital because there was evidence that the surgical wound was infected, likely due to the length of time that the staples were left in place and the lack of dressing changes. The resident was admitted to the hospital to get IV antibiotics for the infection and to have a surgical debridement done of the infected tissue. The orthopaedic surgeon told the state surveyor, “I have had problems with that facility lately and am thinking of mot letting my patients go there anymore.”
There were a number of failures in the care that this resident received. First, there was a basic breakdown of the systems which assure continuity of care. Second, the admitting nurse and almost every nurse after that failed to assess the wound or recognize that treatment was not being provided for it. Third, residents’ skin is normally checked by aides during baths or showers and defects are reported on “bath sheets”. Either this was not done or no action was taken with regard to that. Fourth, the care planning process is intended to be a comprehensive review of the resident’s care needs, and yet, in the process of doing the care plan, the need for wound care and skin assessments was completely missed. The net result of this is that the resident suffered a surgical wound infection, which can be a very grim condition indeed if it requires removal of the orthopaedic hardware. Yet, this is the risk that this resident is being subjected to due to a lack of basic care provided here.
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