The Illinois Department Of Health has cited and fined La Bella Of Danville when a resident experienced recurring infestations of maggots in his leg wounds due to inadequate wound care and dressing changes.
The resident in question was admitted to the facility with multiple diagnoses including acute kidney failure, type II diabetes mellitus, morbid obesity, and various wounds. Despite being cognitively intact, the resident was dependent on staff for proper wound care.
The resident’s wounds were initially evaluated by a Wound Physician, who documented multiple large wounds on the resident’s legs and ordered a specific wound care regimen. This included the application of “0.1% Triamcinolone cream to both legs with 4-layer compression wraps from ankle to knee, twice a week.”
The first incident of maggot infestation occurred approximately five days later. The Wound Nurse reported that “a Licensed Practical Nurse notified her she found maggots in the resident’s leg dressing and in his wheel chair.” This led to a new wound care order from the Wound Physician, including washing the resident’s legs with Betadine and applying new dressings every other day for 30 days.
Despite this intervention, a second maggot infestation was discovered approximately one week later. During an examination, “the Director of Nursing (DON) removed the resident’s right lateral and medial leg wound dressings and the dressing pulled away from the wound contained 7 adult size (length of a diameter of a dime) live maggots.” The DON acknowledged the severity of the situation, stating, “this is the second time the resident has gotten maggots in the facility, as he was notified the resident had maggots in his wounds last Monday. The DON said this is unacceptable care.”
The investigation revealed that prescribed dressing changes were not being performed as ordered. A Registered Nurse had documented completing the dressing changes but later admitted, “we only had three Certified Nursing Assistants (CNAs) and the nurses were having to help pass trays and feed and I just got busy and forgot to do it after I charted it.”
The consequences of this neglect were severe. The resident’s wounds deteriorated significantly. One wound evaluation showed that the resident’s right anterior medial leg wound had increased from 8cm x 5cm to 16cm x 14cm in just six days.
The resident experienced considerable pain due to this neglect. The resident reported that “he had terrible pain in his legs and feet and behind his eye” and that “the pain in his legs had been worse recently, but he didn’t know why, and he needed someone to address it.”
The severity of the situation was acknowledged by multiple healthcare professionals. A Nurse Practitioner stated, “This has to be dealt with immediately. It could have been prevented and it could certainly have made the wound worse causing infection. This is unacceptable care.” The Wound Physician expressed concern about the frequency of dressing changes, saying “based on the size of the maggot, he questioned whether the dressings were being changed as ordered.”
This case highlights a critical failure in providing basic wound care, resulting in unnecessary suffering for the resident, potential for serious infection, and deterioration of existing wounds. It underscores the importance of adhering to prescribed care routines and maintaining adequate staffing levels to ensure proper patient care.
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