Failure to Implement Psychiatric Recommendations for Resident Care
Penalty
Summary
The facility failed to ensure that the medical care of a resident was properly supervised by a physician, particularly in monitoring changes in the resident's medical status. This deficiency was identified for a resident with diagnoses of Schizophrenia, Anxiety Disorder, and Depression, who had intact cognition as indicated by a BIMS score of 13. The resident expressed feelings of unhappiness, loneliness, and lack of primary support, and the psychiatrist recommended exploring options for transferring the resident to another facility of their choice and receiving behavior therapy and counseling. However, the Nurse Practitioner who reviewed these recommendations did not document agreement or disagreement with them, nor did they implement the recommendations. The facility's policy required that physicians approve or document reasons for disagreeing with consultant recommendations. Despite this, the Nurse Practitioner, who was a remote medical provider, did not enter a physician's order for the recommended behavioral counseling services. The resident's primary physician was unaware of the psychiatrist's recommendations, and the medical director stated that the Nurse Practitioner should have referred the resident to social services and entered the necessary orders. The resident expressed a desire to be placed in a group home in Suffolk County, where they previously received psychological services, but this was not facilitated due to the lack of appropriate physician orders.
Plan Of Correction
Plan of Correction: Approved January 17, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** **F 710 – Physician Services** The following plan of correction is submitted in accordance with applicable law and regulation and for continued Medicare/Medicaid certification and does not constitute an admission of fault on the part of the facility. A) Immediate Corrective Action for Resident found to be affected by the deficient practice: 1. Resident #93’s choice to be transferred to another facility was initiated immediately upon notification and resident transferred to a Suffolk County placement. 2. Evaluation by the Social Worker and the Psychologist revealed no psychological harm sustained by resident as a result of this deficient practice. 3. The Attending Physician re-addressed the Psychiatrist’s recommendations dated 10/22/2024 by placing an order for [REDACTED]. 4. The Nurse Practitioner who failed to address the Psychiatrist consult dated 10/21/2024, was re-educated on 12/18/2024 that documented evidence is required in the medical record if there is agreement or disagreement with the consultant’s recommendation and if in agreement, same must be implemented. B) Identification of other Residents having the potential to be affected by the deficient practice: All residents with a Psychiatry consult have the potential to be affected by the deficient practice. The Medical Director will be responsible for conducting an audit of all recommendations made by the Psychiatrist for the past 6 months, to ensure that all recommendations made are reviewed and implemented if applicable; or that there is documented evidence if the physician disagreed with the recommendation. Any negative findings will be immediately corrected. C) Systemic Changes to ensure the deficient practice will not recur: b) The policy and procedure titled “Consultation” was reviewed and found to be in compliance. c) All onsite and offsite attending medical providers will be re-educated on the procedure of: a. Documenting their agreement with a consultant’s recommendation and implementing the physician’s order; or b. Documenting their disagreement and documenting the reason for disagreement. d) Education will be verified by posttests or return demonstration to ensure education retention. Person responsible: Medical Director D) QA – Monitor of the deficient practice: The Medical Director will have the responsibility of auditing 10% of Psychiatry consultations monthly to ensure there is documented evidence of the attending physician addressing any recommendations made. Any negative findings will be immediately corrected and reported to the QAPI committee. This audit will be completed monthly x 6 months. The Medical Director is responsible for the correction of this deficiency. Date of correction: 02/18/2025