Delayed Implementation of Physician Orders and Laboratory Services
Penalty
Summary
The facility failed to ensure that physician's orders were carried out or noted in a timely manner for three residents. In one case, an optometrist ordered antibiotic eye ointment for a resident with blepharitis, but due to a delay in clarifying the order and obtaining an alternative medication from the pharmacy, the first dose was not administered until several days after the initial order. Documentation shows that the pharmacy notified the facility that the originally ordered medication was unavailable, but the process to obtain a new order and administer the medication was not completed promptly. Another resident had a physician's order for ropinirole to treat restless leg syndrome and for laboratory tests to check magnesium, Vitamin D, and iron levels. The medication order was not carried out until the day after it was written, and the laboratory tests were not performed until three days after the order. There was no documentation that the physician was informed of the delay in laboratory testing. Interviews with nursing staff revealed a lack of follow-up and communication regarding the flagged orders, and an assumption that another nurse or LVN would complete the tasks. A third resident had multiple medication orders written, but only some were carried out on the day the order was written. The order for methocarbamol, a muscle relaxant, was not carried out until the following day. Nursing staff interviews indicated that the missed order was due to incomplete follow-through by the assigned LVN, and a lack of verification by the supervising RN. Facility policy requires timely transcription and implementation of physician orders, as well as prompt laboratory services, but these were not adhered to in the cited cases.