Failure to Arrange Timely Neurology Follow-Up and Address New Skin Discolorations
Penalty
Summary
The facility failed to provide appropriate treatment and care according to physician orders and resident needs for two residents. For one resident with a history of seizures and narcolepsy, the facility did not arrange a follow-up neurology appointment within 5 to 7 days as ordered in the hospital discharge summary and by the physician. Documentation showed that the resident was admitted, discharged, and then readmitted to the facility, but there was no evidence of a neurology consult being scheduled until four months after the initial recommendation. The Director of Nursing confirmed that the resident did not see the neurologist within the required timeframe and that there was no facility policy for scheduling appointments. For another resident with chronic conditions including COPD, diabetes, and congestive heart failure, the facility failed to identify, monitor, and notify the physician about multiple new skin discolorations on both hands and the left upper extremity. The care plan indicated the resident was at risk for bleeding and skin integrity issues, and required notification of the physician for any significant changes. However, documentation from body checks did not reflect the presence of the new skin discolorations, and there was no evidence that these findings were communicated to the physician or family, or that a care plan was initiated for the new skin issues. Interviews with nursing staff and the DON revealed that the process for reporting and monitoring new skin problems was not followed. The licensed nurse acknowledged that a change of condition report, incident report, and physician notification should have occurred but did not. The DON confirmed that new skin discolorations should have been investigated and reported immediately, and that the lack of timely identification and communication could delay treatment. Facility policy required incident reporting and physician notification for skin abnormalities, but this was not done in these cases.