Failure to Ensure Physician Orders, Care Planning, and Hospice Coordination
Penalty
Summary
The facility failed to provide appropriate treatment and care according to physician orders, resident preferences, and goals for three residents. For one resident with two skin tears on the left leg, staff applied a Tegaderm dressing instead of the Aquacel foam dressing specified in the facility's wound care protocol. Documentation did not show that a physician was contacted prior to implementing this treatment, and the physician later clarified that proper procedures for obtaining orders were not followed, as there was an on-call provider available and no direct communication occurred before the treatment was initiated. Another resident, admitted with a cardiac pacemaker, had a baseline care plan that included instructions for pacemaker checks but did not specify the method or equipment to be used. The resident reported having a home monitoring machine prior to admission but did not have it in the facility until after the surveyor's inquiry. There was no evidence that the need for a pacemaker monitoring device was identified or addressed in the care plan upon admission, and the device was only brought to the facility after staff were prompted by the surveyor. A third resident, admitted with hospice services for terminal dementia, had a care plan that did not integrate hospice services or specify the hospice provider, disciplines involved, or frequency of services. The care plan lacked documentation of the full range of hospice services to be provided for the management of the resident's terminal illness, and there was no evidence of coordination between the facility and the hospice provider.