Physician Failed to Review Resident's Total Program of Care
Penalty
Summary
The facility failed to ensure that a physician reviewed a resident's total program of care as required. Specifically, a resident with diagnoses including high blood pressure, phantom limb pain syndrome, and constipation experienced a period of six days without a bowel movement. The clinical record showed that the resident did not receive medications as ordered per the bowel protocol during this time. Despite this, the physician's progress note indicated there were no changes in bowel habits, and the resident was described as tending toward constipation with a fair appetite. Further review revealed that the registered nurse documented the absence of bowel movements for six days and noted hyperactive bowel sounds and decreased appetite. Interviews with facility staff, including a certified registered nurse practitioner and the director of nursing, confirmed that the physician did not adequately review the resident's clinical record, including bowel and eating patterns, during the required visit. This failure was identified for one of five residents reviewed.