Failure to Ensure Timely Physician Review and Order Renewal
Penalty
Summary
The facility failed to ensure that two residents with significant psychiatric and cognitive diagnoses received timely physician reviews and order renewals as required. For both residents, clinical record review showed that physician orders were not signed or renewed for a period of 127 days, despite the facility's 60-day schedule for such reviews. The residents had care plans addressing their mental health and behavioral needs, and both were identified as having moderate cognitive impairment. Documentation revealed that the last physician orders were signed in early November, with no further signatures until early March of the following year. Interviews with the Director of Nursing Services (DNS) and the Medical Director confirmed that the required physician order reviews and signatures were not completed within the mandated timeframe. The DNS was unable to provide documentation or an explanation for the lapse, and the Medical Director acknowledged being behind in signing orders, noting a transition to electronic signatures during the period in question. The facility was also unable to provide a policy regarding medical visits when requested by the surveyor.