The Orchards At Armada

follow-up visit with the WCCCS and was sent to the emergency room (ER) for a wound

review of R901's Treatment Administration Record (TAR) for December revealed no documentation

revealed when the wound care treatment changed to the Unna boot dressing, the wound began to deteriorate. At 2:19 PM, PMD C was interviewed. PMD C was asked if an outside provider was directing the care of a resident under their care, and a wound showed evidence of deterioration would they contact that provider. PMD C stated No. PMD C further revealed that for wounds, it would be the WCN or WCNP who would make that call.At 2:42 PM, Wound Care Nurse Practitioner (WCNP) B was interviewed and asked if they were responsible for wound care at the facility when there is an outside provider and said, as a courtesy they may get involved as a second pair of eyes, but that normally they would not be involved. WCNP B confirmed they looked at the wounds and discussed with PMD C but did not document any involvement. WCNP B further revealed it was the responsibility of the facility to contact the outside consulting provider with questions or wound deterioration. A review of the undated policy Skin Management Facility Guidelines was reviewed.

The guidelines indicate: residents admitted with skin impairments will have .-that wound location and characteristics documented; Identify any physical, functional, and/or psychological complications related to an existing ulcer, for example, pain, cellulitis, osteomyelitis, or social isolation.

The guidelines also revealed the Licensed Nurse is to complete an appropriate skin form which includes a description of the ulcer as follows: Non-Pressure Skin Condition Report for all identified non-pressure skin alterations.

The policies for Wound Care and Communication with Outside Consulting Physicians was requested but not received by end of survey.