| 10156 |
CAROLINAS HOSP SYS TRANS CARE |
425177 |
121 EAST CEDAR STREET |
FLORENCE |
SC |
29501 |
2012-02-08 |
314 |
D |
|
|
4V0311 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the Recertification Survey, based on observation, interviews and review of the facility's policy entitled Dressing Changes, the facility failed to provide necessary treatment and services to promote healing and prevent infection for Resident # 1, 1 of 1 residents reviewed for wound care. The findings included: The facility admitted Resident #1 on 12/26/11 with [DIAGNOSES REDACTED]. On 2/8/12 at 9:49 AM, Licensed Practical Nurse (LPN) #2 was observed performing wound care to 5 wounds for Resident #1. After explaining the procedure to the resident, setting up her supplies and clean field, the LPN cut and removed the soiled dressing from the left knee wound. She removed her gloves, washed her hands and donned clean gloves. She then obtained a non-adherent dressing from a shelf on the wall and opened it. She sprayed the periwound with wound cleanser and rubbed around the periwound several times. She then sprayed the wound bed with wound cleanser and dabbed the bed several times right to left then back from left to right. She applied the clean dressing and applied tape. The LPN then removed the dressing from a posterior lower leg wound and discarded the soiled dressing. She removed her gloves, washed her hands and donned clean gloves. She then removed the soiled outer dressing from the anterior foot and heel of the left foot and discarded them. LPN # 2 sprayed wound cleanser on the periwound and cleaned the medial, lateral and distal periwound areas with several wipes without turning the gauze. Wound cleanser was then sprayed on the wound bed, and the LPN dabbed the wound bed with gauze 3 times, went beyond the wound margin into the periwound area then back into the wound bed. A clean gauze was moistened with Normal Saline and applied to the wound bed and a dry gauze was placed over the moist gauze. She removed her gloves washed her hands and donned clean gloves. The soiled inner dressing from the left heel was removed and discarded. LPN # 2 removed her gloves, washed her hands and donned gloves. The LPN sprayed the periwound with wound cleanser and wiped the medial periwound twice, sprayed wound cleanser onto the same area of the gauze and wiped the lateral periwound 3 times. She sprayed the wound bed with the cleanser and wiped 5 times with the same gauze without turning it, left to right and top to bottom, then place a normal saline moist gauze in the wound bed, covered it with the clean dressing and wrapped the foot with Kerlix gauze. She removed her gloves, washed her hands, and donned clean gloves. The LPN then sprayed the posterior lower leg periwound with wound cleanser, wiped the medial periwound and around to the proximal wound twice then 3 times on the lateral periwound and around to the distal area. With a clean gauze she cleaned the periwound a second time wiping the lateral area twice and around the bottom and then back and forth on the medial periwound. She sprayed the wound bed with cleanser and with a clean gauze wiped back and forth 4 times. A normal saline moist gauze was placed in the wound bed, covered with a dry gauze and secured it with tape. The LPN did not change gloves at this time but opened the resident's brief, removed the soiled dressing from the penis and discarded it. She then removed her gloves, washed her hands and donned clean gloves. She obtained an additional package of gauze from the shelf on the wall and opened it. She moistened a gauze with normal saline and wiped the periwound and shaft of the penis 10 times then wiped the periwound 2 more times. The wound bed was cleaned with a normal saline moist gauze with 2 wipes. LPN # 2 then turned the gauze and wiped 6 more times in the wound bed. The LPN then applied Saf Gel to a clean gauze, applied it to the wound bed, placed a dry gauze over that and wrapped with a second dry gauze and secured with tape. The LPN did not change gloves after cleaning any of the wounds before applying the clean dressings. Review of the facility's policy, Dressing Changes, revealed, in the section labeled "Procedure", ...5. Don Clean gloves. 6. Place water proof pad under affected area. 7. Clean wound thoroughly. Pat dry with guaze sponge. 8. Remove gloves and don a clean pair. 9. Apply topical medication ointment as ordered to wound bed and/or periwound area. 10. Apply dressing per physician order [REDACTED]. During an interview at 2:29 PM on 2/8/12, the LPN stated she had "tried to be extra careful" since she was being observed. She stated she thought "some gentle scrubbing would be required" to clean the wound bed. She further stated that she did not think she needed to change gloves between cleaning the wound and applying the clean dressing. The LPN stated that it had not been intentional to go out side the wound bed and into the periwound area when she had cleaned the wound bed. In addition, she confirmed that she had left the posterior lower extremity wound open while she did the dressing changes to the top of the left foot and the left heel. During an interview on 2/8/12 at 3:03 PM, the the Director of Nursing confirmed that the LPN should have changed her gloves after cleaning the wound prior to applying the clean dressing. She also confirmed it was inappropriate to go over the same area of the wound bed with the same gauze and verified the standard of practice is to clean a wound bed in a circular motion from the center outward in one continuous motion. In addition, the DON also confirmed the posterior wound should not have been left open while the dressings were being changed to the foot. |
2014-04-01 |