Failure to Arrange Neurology Follow-Up and Ensure Proper Medication Management
Penalty
Summary
A resident with a complex medical history, including chronic obstructive pulmonary disease, chronic respiratory failure, ischemic heart disease, prior strokes, and a recent episode of encephalopathy with seizure-like activity, was discharged from the hospital with orders to continue Keppra (an anticonvulsant) and to follow up with neurology. The hospital discharge summary specifically noted the need for a neurology consult to determine the long-term plan for Keppra therapy. Upon readmission to the facility, the Keppra order was initiated, but no neurology consult was arranged as directed in the discharge plan. Multiple providers, including nurse practitioners and physicians, were involved in the resident's care following readmission. Documentation shows that the need for neurology follow-up was not addressed in provider notes, and staff interviews revealed confusion or lack of awareness regarding the consult recommendation. In February, a verbal order to discontinue Keppra was entered by a nurse, but there was no documentation of which provider gave the order or the rationale for discontinuation. Interviews with the nurse practitioner and physician involved revealed that neither recalled giving or authorizing the discontinuation, and the responsible party was not notified of the medication change. Subsequently, the resident experienced a seizure requiring emergency intervention and hospitalization. Hospital records and interviews indicated that the resident had not been receiving Keppra at the time of the event, and the hospital neurologist attributed the seizure to the absence of antiepileptic medication. The facility's failure to arrange the neurology consult and to ensure proper documentation and communication regarding the discontinuation of Keppra directly contributed to the resident not receiving appropriate follow-up and medication management as ordered.