Failure to Transcribe and Implement Physician Orders for Foot Monitoring
Penalty
Summary
The facility failed to follow professional standards of care by not transcribing and implementing physician orders to monitor a resident's right foot for increased discoloration, assess pedal pulse, and monitor temperature changes. The resident had a history of occlusion and stenosis of the right carotid artery, essential hypertension, anemia, and chronic ischemia. After the resident complained of discoloration in her right foot, a nurse practitioner assessed the foot, noted it was cool to the touch with edema, and ordered a doppler ultrasound, which was negative for DVT. Despite the negative result, the plan was to monitor the foot for changes, but the nurse practitioner did not specify a time frame for monitoring and only gave a verbal order to an unidentified nurse. Subsequent interviews revealed that the LPN who cared for the resident after an unwitnessed fall was unaware of any orders to monitor the right foot and did not perform a head-to-toe assessment. The CNA reported the presence of a blister and that the foot was wrapped by a nurse. The medical doctor confirmed the resident's chronic ischemia and agreed with the monitoring orders. However, review of the resident's physician order sheet and progress notes showed no documentation of orders or monitoring for the right foot on the relevant dates. The facility's policy requires all physician orders to be transcribed and implemented, but this was not done in this case.