Delays in Medical Interventions, Medication Administration, and Care Planning
Penalty
Summary
The facility failed to provide adequate and appropriate health care to several residents as evidenced by multiple deficiencies in timely medical interventions and documentation. For one resident, there was a significant delay of 22 days between the collection of a wound culture and its receipt by the laboratory, resulting in a delay in effective treatment for an infection with a drug-resistant organism. The Assistant Director of Nursing was unable to explain the cause of this delay, and the resident was started on an antibiotic to which the organism was resistant, further delaying appropriate care. Another resident did not receive a timely urology consult as ordered by the physician. Despite documentation of the need for a referral and follow-up, there was no evidence that the referral was completed before the resident was transferred to the hospital. The staff member responsible for referrals acknowledged the lack of follow-up. Additionally, there was a delay in obtaining a required culture for this resident, with no explanation provided by the Assistant Director of Nursing. Medication administration was also found to be deficient, with one resident receiving multiple medications outside the facility's policy of administering within one hour before or after the scheduled time. Some medications were administered as late as three hours after the scheduled time, and the resident confirmed receiving medications late on several occasions. Furthermore, another resident was observed using a CPAP machine daily without a physician's order or a care plan in place for its use until the last day of the survey, after surveyor intervention.
Plan Of Correction
On Resident #12 was assessed by the provider. On is healing without complications and no s/s of current . On resident #92 was evaluated by the provider with no acute findings noted. On the medical records/staff made the consult for resident #1. On resident #1 was reevaluated by the provider with no acute findings. On additional CPAP orders were obtained for Resident #304. On , the care plan for a CPAP was revised by the Regional Nurse Consultant. On , the Regional Nurse Consultant conducted a quality review of current residents with cultures ordered in the past 30 days to ensure that the culture was obtained within the appropriate time frame. No additional findings were noted. On , the Regional Nurse Consultant conducted a quality review of medication administrations for the past 24 hours. Follow up based on findings. On , the Regional Nurse Consultant conducted a quality review of current residents with to ensure physician orders for consults and cultures in the past 30 days have been followed timely. No additional findings were noted. On DON conducted a quality review of current residents who require the use of a CPAP to ensure proper physician orders and care plans were in place. No additional findings were noted. By licensed nurses were educated by the Staff Development Coordinator on the components of N201 with an emphasis on obtaining cultures timely and administering medications timely. As a systematic change, newly hired licensed nurses will be educated on the components of N201 with an emphasis on obtaining cultures timely and administering medications timely during orientation. By licensed nurses were educated by the Staff Development Coordinator on N201 with an emphasis on obtaining consults and cultures timely. As part of a systematic change, newly hired licensed nurses will be educated on N201 with an emphasis on obtaining consults and cultures timely. By licensed nurses were educated by the staff development coordinator on the components of N201 with an emphasis on obtaining appropriate physician orders for use of a CPAP as well as implementing a care plan for the CPAP. As part of a systematic change, newly hired licensed nurses will be educated on the components of N201 with an emphasis on obtaining appropriate physician orders for use of a CPAP as well as implementing a care plan for the CPAP during orientation. DON/Designee will conduct quality monitoring of order listing reports 5 times weekly x 4 weeks, then 5 monthly x 2 months to ensure that cultures ordered are obtained timely. DON/Designee will conduct quality monitoring of 5 random residents weekly x 4 weeks, then 10 random residents monthly x 2 months to ensure that medications are administered within the appropriate time frame. The findings of these quality monitoring to be reported to the Quality Assurance/Performance Improvement Committee monthly until the committee determines substantial compliance has been met. DON/Designee will conduct quality monitoring of order listing reports 5 times weekly x 4 weeks, then 10 order listing reports monthly x 2 months to ensure that cultures and consults are obtained timely. The findings of these quality monitoring to be reported to the Quality Assurance/Performance Improvement Committee monthly until the committee determines substantial compliance has been met. DON/Designee will conduct quality monitoring of 3 residents who require CPAPs weekly x 4 weeks and 5 residents who require CPAPs monthly x 2 months to ensure that proper physician orders and care plans are in place. The findings of these quality monitoring to be reported to the Quality Assurance/Performance Improvement Committee monthly until the committee determines substantial compliance has been met. N 201 N 201