Failure to Provide Timely Specialist Appointment and Consistent Wound Care
Penalty
Summary
A deficiency occurred when a resident with type 1 diabetes mellitus did not have a timely endocrinology appointment scheduled as ordered by the physician. The order to set up an appointment with the endocrinologist was first made and later revised to specify the provider, but documentation showed only a single progress note indicating a message was left with the endocrinology office. There were no further notes confirming that an appointment was scheduled until much later, and the resident reported not being informed about any appointment. The nurse practitioner stated the need for the appointment was due to the resident's complex diabetes management, and the DON confirmed the appointment was only recently scheduled, despite the earlier order. Another deficiency was identified for a resident with moisture-associated skin damage and a diagnosis of diabetes and incontinence, who did not consistently receive wound dressings as ordered. The treatment administration record showed multiple missed dressing changes over several days, despite a physician's order for twice-daily wound care. The plan of care included providing treatment as per the physician's order, but interviews revealed that missed treatments were attributed to either lack of notification from a QMA to a nurse or lack of documentation by the nurse if the resident was not on their scheduled assignment. Both deficiencies were supported by facility policies that require following physician orders and ensuring residents receive appropriate care and treatment. The survey findings were based on record reviews, resident and staff interviews, and facility policy review, confirming that the facility failed to provide timely specialist appointments and consistent wound care as ordered for the residents involved.