Failure to Follow Physician's Orders for Resident Care
Penalty
Summary
The facility failed to follow physician's orders for three residents, leading to deficiencies in care. Resident R69, who had a history of stroke, breast cancer, and high blood pressure, was observed multiple times without the prescribed left arm sling and soft cervical collar, which were ordered to be worn at all times except for specific activities. The Regional Nurse Consultant confirmed the non-compliance with the physician's orders during an interview. Resident R17, diagnosed with hypothyroidism and hyperlipidemia, did not have a scheduled dermatology appointment as ordered by the physician for a skin rash. The appointment was canceled due to COVID, and there was no evidence of rescheduling. The Director of Nursing confirmed the failure to schedule the Telederm appointment. Additionally, Resident R65, with hemiplegia and hypertension, was observed without the required contracture boot on the right foot/ankle on several occasions, despite physician orders and care plan interventions. The Director of Nursing confirmed the absence of the boot, acknowledging the failure to adhere to the physician's orders.
Plan Of Correction
1. Resident R69 was addressed immediately to ensure sling and collar were on and Dr. notified. R17 order for the telehealth visit was discontinued as per physician. R65 order for boot was discontinued after consultation with therapy as it was deemed it was no longer necessary for the patient. 2. Director of Nursing or designee will audit 5 residents weekly for three weeks to review physician orders are being followed. Redline process, review of all new orders, discontinued orders, labs and appointments, will be put into place for third shift supervisor to review all new orders and discontinued orders daily. 3. Director of Nursing or designee will educate Licensed staff and certified nursing aids on Verbal physician care orders and physician orders. Reviewed with staff on where to see orders/tasks for residents and to ensure those measures are in place for each resident. 4. Audits of 5 residents per week x 3 weeks on care orders and appointments to ensure they are active and in place. Audits will be completed 5 residents per week x 3 weeks and monthly until cleared by quality assurance meeting.