Failure to Clarify Physician Order for Topical Steroid After Pharmacist Recommendation
Penalty
Summary
The facility failed to clarify a physician's order for hydrocortisone cream as recommended by the consultant pharmacist during the monthly medication regimen review for one resident. The resident had been readmitted with multiple diagnoses, including Type 2 diabetes, rash, schizophrenia, dementia, and psychosis. The physician's order directed the use of 1% hydrocortisone cream to the right side of the nose and face every six hours as needed for itching, but did not include an end date, allowing for indefinite use. During the consultant pharmacist's medication regimen review, it was noted that the order for hydrocortisone cream lacked a stop date. The pharmacist recommended that the topical steroid be used for no more than four weeks at a time and advised facility staff to request the physician to add a stop date or discontinue the medication. Despite this recommendation, the order remained unchanged and the cream continued to be available for indefinite use. Interviews with facility staff, including an LVN and the DON, confirmed that the pharmacist's recommendation was not acted upon. Both staff members acknowledged that recommendations from the consultant pharmacist should be communicated to the physician and followed up, but in this case, the order was neither clarified nor discontinued as advised. The facility's policy required that such recommendations be acted upon and documented, but this process was not completed for the resident in question.