Failure to Notify Physician of Ongoing Orthostatic Hypotension and Lack of Physician Involvement in Therapy Discontinuation
Penalty
Summary
The facility failed to notify the physician of a resident's ongoing episodes of orthostatic hypotension (OH) and did not ensure physician involvement in the discontinuation of Physical and Occupational Therapy (PT, OT) services. The resident, who had a history of OH, falls, pleural effusion, diabetes mellitus, postprocedural pneumothorax, and muscle wasting, was admitted with intact cognitive skills and required substantial assistance with activities of daily living. Despite being prescribed PT and OT services, the resident experienced repeated episodes of OH during therapy sessions, which were reported to nursing staff but not communicated to the physician after an initial notification and medication order. The lack of further physician notification occurred even though the resident continued to have symptoms despite treatment with Midodrine. The PT progress notes documented the resident's ongoing need for therapy and the presence of OH during sessions, but there was no evidence that the physician was informed of the continued symptoms or the ineffectiveness of the prescribed medication. Interviews with nursing staff revealed that they were aware of the resident's ongoing OH but could not recall why the physician was not notified. The physician confirmed that he was not made aware of the continued episodes and would have considered additional interventions if informed. The failure to communicate these changes in the resident's condition resulted in a delay in appropriate medical intervention and placed the resident at risk for adverse outcomes. Additionally, the discontinuation of PT and OT services was not properly coordinated with the physician. The order to discontinue therapy was placed by the health plan and the Director of Rehabilitation, not by the physician, and the physician was not aware of or involved in the decision to end therapy services. Facility policy required physician involvement in the rehabilitation plan of care and communication of changes in condition, but this was not followed. The lack of physician involvement in both the management of the resident's OH and the discontinuation of therapy services contributed to the premature termination of Medicare coverage and compromised the resident's care.