Failure to Ensure Physician Conducted Initial Visit
Penalty
Summary
The facility failed to ensure that a physician completed the initial visit for a resident, identified as Resident R2, as required by federal regulations. According to the clinical records, Resident R2 was admitted to the facility with diagnoses of anemia, bacteremia, and heart failure. The initial visit was conducted by a Certified Registered Nurse Practitioner (CRNP), Employee E17, instead of a physician, which is a violation of the regulation that mandates a physician must personally conduct the initial visit. Further review of Resident R2's clinical record showed that a history and physical visit was completed by Medical Doctor, Employee E15, but it was noted that the resident was not seen and was still in the hospital at that time. During interviews, both the Medical Doctor, Employee E15, and the Director of Nursing confirmed the failure to have a physician complete the initial visit. The Medical Doctor also expressed a misunderstanding of the regulation requirements.
Plan Of Correction
F-712 Physician Visits - Frequency/ Timeliness/ Alt NP 1. The cited areas cannot be corrected. 2. An audit of new admissions will be conducted by the Administrator or designee for the past 30 days to determine compliance with the regulation. 3. The Medical Director, attending physician, and nurse practitioners will be educated on regulation F-712 by the Director of Nursing or designee. 4. Audits will be completed by the Administrator or designee for the completion of the Comprehensive Visits by the physician within 10 days on all new admissions weekly for 3 weeks and then monthly for 2 months. A summary of the audits will be reviewed in the monthly QAPI for 2 months by the Administrator or designee.