Failure to Obtain Timely Physician Orders for Resident Care
Penalty
Summary
The facility failed to ensure that a physician provided necessary orders for a resident's immediate care and needs upon admission. Resident 325, who was admitted from the hospital, had several medical conditions including stage two chronic kidney disease, diabetes mellitus type II, and a stage three pressure ulcer to the sacrum. Upon admission, the resident also had a Foley catheter in place. However, the clinical record review revealed that there were no physician orders for the treatment of the sacral pressure ulcer or the care of the Foley catheter at the time of admission. The deficiency was identified when it was found that the orders for the sacral pressure ulcer treatment were not made until five days after admission, and the orders for the Foley catheter care were not made until six days after admission. This lack of timely physician orders for critical care needs was confirmed during a staff interview with the Director of Nursing, who acknowledged that it was the facility's expectation for such orders to be provided upon admission.
Plan Of Correction
Resident 325 had orders placed for care of the Sacral Pressure Ulcer and Foley Catheter and did not have any adverse effects from the delay in orders. A comprehensive review of all current residents with Pressure Ulcers and/or Foley Catheters will be conducted to ensure that wound treatment orders and Foley catheter orders are in place as ordered by MD. The facility will take further steps to ensure that the problem does not re-occur by in-servicing licensed nursing staff on F Tag 710 with a focus on Pressure Ulcer treatment and Foley catheter orders and re-educating licensed nurses on ensuring that wound care orders and Foley catheter orders are entered on admission. Compliance will be monitored by the Director of Nursing/Designee using Wound Treatment and Foley Catheter Audit to review all new admissions weekly x 3 weeks, then a random audit of 5 admissions monthly x 2 months to ensure that wound treatment orders and Foley catheter orders are in place as ordered, with audit results being forwarded to the QAA committee to determine the need for further follow up/monitoring.