Failure to Timely Address Pharmacy Recommendations by Physician
Penalty
Summary
The facility failed to ensure that pharmacy recommendations were reviewed and addressed by a physician in a timely manner for multiple residents. For one resident with multiple chronic conditions, pharmacy recommendations regarding necessary lab monitoring for anticoagulant therapy, discontinuation of a sedating muscle relaxant, and evaluation of duplicate antihypertensive therapy were not addressed by a physician for several weeks to months. Documentation showed that the recommended labs and medication changes were delayed, and the resident continued on the medications until well after the recommendations were made. Another resident with complex psychiatric and medical diagnoses was receiving multiple medications, including anticoagulants and anti-inflammatories. The pharmacist recommended discontinuing Naproxen due to bleeding risk, limiting the duration of an as-needed anxiolytic, and obtaining regular blood counts to monitor for bleeding. These recommendations were not addressed by the physician in a timely manner, with some responses delayed by over a month and others not documented at all, despite the physician being present in the facility weekly. A third resident with chronic venous insufficiency and psychiatric diagnoses had pharmacy recommendations for a gradual dose reduction of a sleep aid and re-evaluation of antihypertensive therapy. These recommendations were also not addressed by a physician until two months after they were made. Interviews with the DON confirmed the lack of timely physician response to pharmacy recommendations, and no additional evidence was found to show that the recommendations were addressed promptly.