Failure to Provide Adequate Hydration, Medication Administration, and Physician-Ordered Consultations
Penalty
Summary
The facility failed to provide adequate and appropriate health care to several residents as evidenced by multiple deficiencies. One resident on a 1200 mL per day fluid restriction, with specific allocations for dietary and nursing staff, was not able to access the fluids she was allowed. The resident reported that staff repeatedly removed her juice before she could finish it, despite her requests to leave it for her to sip throughout the day. Observations confirmed the resident's complaints, and staff acknowledged the issue but only offered to replace the juice after it was taken away. Another resident with a severe cognitive impairment had a physician's order for a specific cream to be applied to affected skin areas during the day and evening shifts. Despite this order, the cream was not available for use, as the supply had run out and expired stock had been discarded without timely reordering. Staff interviews revealed that the cream had been unavailable for several days, and the Treatment Administration Record showed that nurses had signed off on the administration of the cream even though it was not actually provided. The resident was observed scratching her arms and had visible skin issues, indicating the treatment was not being administered as ordered. A third resident with a history of hypertension had physician orders for routine and as-needed antihypertensive medications, with instructions to administer the as-needed medication for blood pressure readings above a certain threshold. However, staff were not consistently monitoring or documenting the resident's blood pressure every eight hours as required, resulting in missed opportunities to administer the as-needed medication when indicated. Interviews with nursing staff revealed inconsistent practices in monitoring and documentation, and review of records confirmed that blood pressure readings were not taken or recorded as frequently as ordered. Additionally, another resident did not receive a required follow-up consultation as ordered by the physician, with no documentation of refusal or completion.
Plan Of Correction
1. Resident #16 was provided with additional fluid; no other residents were affected by the deficient practice. Resident's BIM score was redone and now 11. Psych services provided for emotional support and Licensed nurses and Certified Nursing Assistants were educated on sufficient fluid intake to maintain proper hydration and health. Additionally, not removing the fluids allowed to the residents. Care plan updated to reflect resident's preference to sip on her drink throughout the day. Facility audit completed for residents on fluid restrictions to ensure they are receiving adequate hydration as ordered. Director of Nursing/Designee to audit/monitor documentation weekly times four weeks. Assistant Director of Nursing/designee will re-educate nursing staff on the following: Ensure residents with fluid restrictions have adequate time for consumption. Will conduct audits weekly times four weeks. Director of Nursing/designee will report findings at monthly QAA&C meetings monthly times three months or until substantial compliance is achieved. 2. The was obtained from the vendor and provided the unit on in the afternoon. Resident #5 was provided with the cream as ordered. The Physician for Resident #5 was notified and will continue with treatment plan. Resident #5 had physician and family notified of medication omissions and new orders received for medication administration with no negative outcomes to the patient. Nurse D, Staff F, and Unit Manager were re-educated on the process of following physician orders and timely ordering of supplies. Central Supply Clerk re-educated on timely ordering of supplies. 3. Resident #58 medication was given as ordered. Medication review completed by physician and the continued to be as needed Q 8 hours. Order provided to monitor three times/day and as needed. Licensed nurses were re-educated on documenting the for Resident #58 every eight hours as ordered and PRN. 4. Resident #63's consultation was rescheduled from to per family request. The physician was notified of the change of the consultation date. A facility-wide audit was completed for current residents to identify any other residents affected by the deficient practice. No other residents were affected by the deficient practice. Current residents' Treatment Administration Records have been audited by the Director of Nursing/designee to ensure compliance with following physicians' orders. Licensed nurses will be re-educated on the importance of following physician orders related to Quality of Care including customer service, monitoring, and follow-up care for those residents with rashes, medication monitoring, and ensuring consultations are scheduled timely. Compliance will be monitored through audits three times a week, four weeks, and weekly thereafter to ensure the practice does not recur. The Director of Nursing/designee will conduct treatment observations and consultation audits weekly for four weeks and then monthly for two months to ensure continued compliance. The Director of Nursing/Designee will report the findings of the audits to the QAA&C monthly times three months or until substantial compliance is met.