Failure to Schedule Specialist Appointments and Timely Medication Administration
Penalty
Summary
The facility failed to provide appropriate nursing care and services for several residents, as evidenced by missed specialist appointments and delayed medication administration. One resident with a history of cerebral infarction, benign prostatic hyperplasia, mood disorder, major depressive disorder, and dementia was not scheduled for a stat urology consult as ordered, and there was no evidence of follow-up for an MRI with sedation as requested by the family and recommended by the neurologist. Multiple interviews with staff revealed a lack of awareness regarding the need for these appointments, and the transportation coordinator was not informed of the required consults. The Director of Nursing acknowledged that insurance issues may have contributed to the delay, but this was not documented in the resident's chart, and there was no facility policy available for review regarding appointment scheduling. Additionally, two residents did not receive their medications within the required time frame. One resident with chronic obstructive pulmonary disease, diabetes mellitus, and hypokalemia had multiple medications, including antihypertensives, diuretics, steroids, and inhalers, administered several hours after the scheduled time. Another resident with Parkinson's disease, mood disorder, anemia, major depressive disorder, and neurocognitive disorder with Lewy bodies received gabapentin for pain significantly later than scheduled. Staff interviews confirmed that late medication administration was a recurring issue, attributed to staffing challenges and difficulties locating residents at the time of medication pass. The facility's medication administration policy requires medications to be given within 60 minutes before or after the scheduled time unless otherwise ordered by a physician. Despite this, audit reports and staff interviews confirmed that medications were routinely administered outside of this window. The Director of Nursing stated that late medication administration is not acceptable and that nurses should receive assistance if they are unable to complete medication passes on time.