Failure to Follow Physician's Orders and Document Care
Penalty
Summary
The facility failed to follow physician's orders for care and treatment for five residents. Resident 1, who was cognitively impaired and frequently incontinent of bowel, did not receive Milk of Magnesia as ordered for constipation over a four-day period. The Director of Nursing confirmed the lack of documentation for the administration of the medication. Resident 24, who was cognitively intact and had Alzheimer's disease, did not have a left hand palm guard applied as ordered. The resident reported that the staff often forgot to apply it, and the Director of Nursing confirmed the order was not transcribed correctly. Resident 26, who was cognitively intact with a history of stroke and diabetes, did not receive appropriate care for low blood sugar as per the hypoglycemic protocol. Additionally, insulin lispro was not administered on multiple occasions as ordered. The Director of Nursing confirmed these lapses in care. Resident 37, who had diabetes and renal insufficiency, required monitoring of a percutaneous drain output, but there was no documented evidence of this monitoring over several months. The Director of Nursing confirmed the lack of documentation. Resident 38, who was moderately cognitively impaired with end-stage renal failure and hypertension, did not receive insulin Lantus and amlodipine as ordered on multiple occasions. The Director of Nursing confirmed that the orders were not transcribed correctly, leading to missed medication administrations. These deficiencies highlight a pattern of failure to adhere to physician's orders and document care appropriately for multiple residents.
Plan Of Correction
Resident 1 unable to retroactively address bowel movements, Medical Director (MD) notified. Resident 24 palm guard order was reviewed and updated to include documentation. MD notified. Resident 26 unable to retroactively address hypoglycemic protocol administration documentation, MD notified. Resident 26 insulin orders were reviewed, and resident is receiving insulin as ordered. MD notified. Resident 37 orders were reviewed and updated to include an order to record percutaneous drain output every shift. MD notified. Resident 38 medication administration orders were reviewed and adjusted to dialysis times. MD notified. Residents receiving medications and treatments have the potential to be affected. Licensed staff educated by the Director of Nursing on following physician orders for care and treatment (e.g. order transcription, evaluation, parameters, documentation, physician notification). Code update in Electronic Medical Administration Record (EMAR) to document when glucose level does not require insulin coverage per sliding scale. Education was provided to licensed staff on the new EMAR code. Monitoring will be captured through auditing Medication administration. Audits will be completed as follows: 2 staff med pass observations will be conducted weekly for 4 weeks, then 4 staff med pass observations will be conducted 2 times monthly for 2 months. The med pass observations will be conducted by the Director of Nursing or designee. Results of the med pass observations will be provided to the Administrator and be presented for review at the monthly Quality Assurance Improvement Committee (QAPI) meeting monthly for a period of three months. Any revisions to the audit plan will be reviewed and implemented with coordination of the.