MARIETTA, GA – SIGNATURE HEALTHCARE OF MARIETTA

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review, review of policy and procedures, review of the Georgia Nurse Practice Act (chapter 410-10), family and staff interviews, the facility failed to ensure services met professional standards as evidenced by the provision of ongoing wound care to one resident (#1) without a physician’s orders [REDACTED]. Failure to follow the physicians orders for wound care resulted in the resident being hospitalized , subsequently, with a [DIAGNOSES REDACTED]. R#1 had an AV shunt on the left arm at the time that a self-adhering (constrictive) dressing was applied. The sample size was three.

During an interview on 1/10/19 at 10:58 a.m. with A, the family member of R#1, revealed the resident was admitted to the facility in early (MONTH) for rehabilitation. On (MONTH) 27, another family member B received a call from the facility saying the resident had sustained a cut the tip of one of his fingers with a finger nail clipper. During the call, staff reported to family member B that the injury was bleeding, but that the injury was being taken care of. Family member B reported this to family member A who visited the facility the following day, 12/28/18, where he saw the resident’s finger wrapped in a bandage. Family member B accompanied by another member of the family visited with R#1 on 1/1/19. When these family members pulled the bandage away to peek at the finger, they reported to A that there was a noticeable difference in the area below the bandage when compared with the area around the bandage. The finger, in question, looked smaller than the resident’s other fingers, and was black while the surrounding areas and other fingers were white. When the family members had the nurses remove the outer bandage, they discovered that there were two bandages wrapped on top of each other – the wound was covered by a Band Aid, then the Band Aid was wrapped in gauze, then the gauze was wrapped in an elastic bandage (family member A described this as a bandage similar to what one would use to wrap one’s knee). The nurses took the bandages away before the family could take them. However, family member A said the bandage/dressing the family found on the resident’s finger when they visited on 1/1/19 appeared to be the same one he saw on the resident’s finger when he visited on 12/28/18. He was convinced it was the same bandage because the family members that visited on 1/1/19 took pictures which they forwarded to him. In those pictures, the bandage appeared the same. Family member A met the resident and other family members at the hospital later that day. The resident was admitted to the hospital for a couple of nights and was seen by the surgeon. The surgeon advised that surgery would be too dangerous, given the resident’s health conditions, and recommended that the finger be left to wither and fall off on its own – let the body expel it – because it had dry gangrene.

During a telephone interview on 1/11/19 at 3:01 p.m., family member B said R#1 was still wearing what appeared to be the original bandage when the family visited on 1/1/19 and this prompted them to ask when it was last changed. Family member B also said he remembered the wound was wrapped in several layers.