Failure to Schedule Specialist Examinations and Discontinue Medication
Penalty
Summary
The nursing staff failed to obtain and schedule necessary specialist examinations for two residents, as indicated by physician orders. Resident R16, who has a diagnosis of vertigo and cerebral palsy, was not scheduled for an ENT or neurologist examination despite orders from a nurse practitioner. The resident reported dizziness and a preference to remain in a supine position due to these symptoms, yet no orthotic device was used to alleviate her condition. The lack of follow-through on these orders was confirmed by both the licensed nurse and occupational therapist, as well as the Director of Nursing. Additionally, Resident R315 continued to use Chlorhexidine Gluconate oral rinse after the medication had been discontinued by the physician. The resident, who was admitted with multiple fractures and lacerations from a motor vehicle accident, was observed using the mouth rinse after meals, despite the order being discontinued. This oversight was confirmed by the Director of Nursing, indicating a failure in medication administration practices.
Plan Of Correction
This plan of correction is submitted to comply with Federal Regulations. This plan is not an admission of guilt, or wrongdoing, nor does it reflect agreement with the facts and conclusions stated in the statement of deficiencies. Appointments: - Appointments for Resident R16 were scheduled for both ENT and Neurology. - An audit of Physician progress notes and physician recommendations for the past 2 weeks were completed to ensure that appropriate follow through was made for any follow up appointments ordered by the Provider. - Education will be provided to Nursing staff to ensure that all Physician recommendations requesting consultation follow up are followed through with. - DON/Designee will audit Physician recommendations to ensure appointments are made as recommended. Audits will be done weekly x4 weeks and monthly x2 months. Results of these audits will be reviewed at the Quality Assurance Meeting to determine if further action is needed. Medication Left Bedside: - Medication for Resident R315 was removed from the bedside. - All rooms were checked to make sure there were no medications at the resident's bedside. - Education will be provided to nursing staff to ensure that completed/discontinued medications are disposed of per facility protocol. - DON/Designee will complete random audits to ensure that medications that have been completed or discontinued are disposed of per facility protocol. Audits will be done weekly x4 weeks and monthly x2 months. Results of these audits will be reviewed at the Quality Assurance Meeting to determine if further action is needed.