Failure to Develop and Implement Care Plan for Repeated Refusal of Podiatric Treatment
Penalty
Summary
The facility failed to develop and implement a comprehensive, person-centered care plan to address a resident's repeated refusal of podiatric treatment for onychomycosis and an ingrown toenail. The resident, who had a history of postherpetic trigeminal neuralgia, secondary parkinsonism, and peripheral autonomic neuropathy, was assessed multiple times by a podiatrist and consistently refused toenail care and treatment on four documented occasions. Despite a physician's order for podiatry services and ongoing issues with the resident's toenails, including a partially black left great toe and reports of intermittent bleeding, there was no evidence that the refusals were addressed in the care plan. Interviews with nursing staff revealed a lack of awareness regarding the resident's repeated refusals of toenail care and treatment. The registered nurse assigned to the resident was not informed of the refusals, and the podiatrist's assistant typically reported to the charge nurse, but it was unclear if this information was communicated effectively. The RN Supervisor confirmed that there was no care plan in place to address the resident's refusals or to provide education about the risks associated with refusing care. A review of facility policies indicated that when a resident refuses treatment, staff are required to discuss risks and benefits, assess the reasons for refusal, provide education, and offer alternative treatments, all of which should be documented in the care plan. However, the Director of Nursing confirmed that there was no documentation of an interdisciplinary team meeting, no care plan addressing the refusals, and no evidence that alternative treatments or education were provided to the resident. This lack of action resulted in the resident's needs not being comprehensively addressed as required.