Deficient Physician Services and Lab Monitoring in LTC Facility
Penalty
Summary
The facility failed to provide competent physician services for the treatment and monitoring of diagnoses for eleven residents. This deficiency was evidenced by the lack of monitoring and consultation for medication levels, which led to serious harm for one resident. The resident's medication levels were not monitored, and consultation was not obtained as requested by the provider, resulting in the resident experiencing a severe medical event and requiring transfer to a higher level of care. The report details multiple instances where residents' lab results were not properly monitored or communicated to the appropriate medical personnel. For example, one resident had low medication levels that were not reported to the physician, and another resident's critical lab results were not communicated in a timely manner. Additionally, there were failures in ensuring that lab orders were entered into the lab portal, leading to missed or delayed lab draws. Interviews with facility staff, including the Director of Nursing (DON), revealed systemic issues in the lab process, such as the lack of a designated person to oversee lab results and ensure follow-up. The DON acknowledged that the facility's process for managing lab orders and results was broken, contributing to the failure to provide adequate medical supervision and care for the residents.
Plan Of Correction
Residents Care Supervised by a Physician. 1. What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice. Resident #5 and #10 no longer reside in facility. Laboratory orders for medication management were received for residents #1, #2, #3, #4, #6, #7, #8, #9, and #11. Results of labs were reported to resident physicians, documented in the clinical record, and new orders were transcribed as indicated. Consult was for resident #1 as requested by physician. 2. How you will identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken. Facility-wide audit of current residents on medications was conducted by Director of Nursing/designee to ensure that residents on medications had appropriate lab monitoring orders in place and consults have been completed as indicated. Any residents identified without lab monitoring orders were reported to physician and new orders transcribed as indicated. Any prior consultation orders not properly executed were scheduled. 3. What measures will be put into place or what systematic changes you will make to ensure that the deficient practice does not recur. Director of Nursing/Designee will educate licensed nursing staff on ensuring appropriate physician oversight of resident care related to the lab monitoring process, ensuring that residents on medication receive proper lab monitoring, physicians are notified of abnormal lab values or refused labs, outside providers are consulted as indicated, and documentation of physician notification and new orders is recorded in the resident clinical record. 4. How the corrective action(s) will be monitored to ensure the deficient practice will not recur i.e. what quality assurance program will be put into place. Director of Nursing/Designee will randomly audit residents on medications to ensure that the results of lab orders for monitoring medication levels have been reported to the physician, new orders are transcribed as indicated, and consultation orders for outside providers are completed as indicated. Audits will be performed weekly for four weeks and then monthly for two months. Results of the audits will be submitted by the Director of Nursing/designee to the Quality Assessment, Assurance, and Compliance Committee monthly for three months for further recommendations and guidance.
Removal Plan
- The Regional Nurse Consultant educated the Administrator and Director of Nursing on ensuring a competent physician process is in place for residents with diagnoses.
- A consulting was credentialed with Point Click Care access and on site.
- The Consultant Physician provided education to facility Medical Director and physician extender on the process for monitoring therapeutic lab levels for residents with diagnoses and the medication prescribing standards for such.
- The Director of Nursing or designee educated 100% of licensed nursing staff on the process for ensuring that consultation orders are completed, lab work is ordered for residents on medications, abnormal lab results are reported to physicians, and new orders are transcribed appropriately.
- Process Change: The Director of Nursing is responsible for making sure that a competent physician process is in place for residents with diagnoses.
- Education and in-service sign-in sheets were reviewed and validated with 12 out of 18 licensed nursing staff on the process for ensuring that consultation orders are completed, lab work is ordered for residents on medications, abnormal lab results are reported to physicians, and new orders are transcribed appropriately.
- Interviews were conducted with 10 licensed nurses across various shifts, the Assistant Director of Nursing, the DON, and the Medical Director. The staff members were able to verbalize they had been trained and were knowledgeable about the new policies.