Failure to Follow Physician Orders and Timely Address Skin Conditions
Penalty
Summary
The facility failed to provide treatment and care in accordance with physician orders and professional standards for two residents. One resident with a history of alcohol-induced persisting dementia, dermatitis, and psoriasis experienced ongoing issues with thick, scaly, and cracked skin on his hands. Despite multiple physician orders and dermatologist recommendations to switch topical medications, the facility did not timely discontinue the previous medication or initiate the newly prescribed treatment. Documentation showed that the resident continued to receive the discontinued medication, and the new order was not entered or administered as directed. Additionally, the resident's care plan did not address his skin conditions, and required consent forms for dermatology visits and procedures were missing from his record. Another resident, diagnosed with schizoaffective and depressive disorders, developed a generalized skin rash affecting multiple areas of her body. The rash was initially documented by staff, but there was a delay of several days before the physician was notified. The initial treatment order only addressed a limited area, despite the rash spreading to other regions. The referral to dermatology was not obtained until weeks after the rash was first noted and had extended to additional body areas. Interviews with staff revealed inconsistent awareness of the extent of the rash and incomplete communication regarding the resident's condition. In both cases, the facility did not ensure that physician orders were followed promptly or that care was provided in accordance with professional standards. There were lapses in communication, documentation, and timely implementation of prescribed treatments, resulting in residents not receiving appropriate care for their skin conditions as ordered.