Failure to Follow Physician Orders and Monitor Resident Conditions
Penalty
Summary
The facility failed to follow physician orders and care plans for multiple residents, resulting in deficiencies related to medication administration, skin condition monitoring, and implementation of specialist recommendations. For one resident with type 2 diabetes and Parkinson's disease, insulin was administered despite blood glucose levels being below the physician-ordered threshold for holding the medication. Similarly, another resident with hypertension received Metoprolol even when blood pressure readings were below the parameters set by the physician, indicating a failure to hold the medication as ordered. In addition, the facility did not adequately monitor or document skin conditions for residents at risk. One resident on anticoagulant therapy had a large area of purplish discoloration on the hip, but this was not consistently documented in weekly skin reviews as required by facility policy. Another resident with a history of vascular dementia and bowel incontinence experienced frequent episodes of diarrhea, which were reported by CNAs but not documented in nursing notes or addressed with appropriate medication orders. A further resident with a venous stasis ulcer had an open, raw area on the leg that was not treated or care planned for several days, despite visible symptoms and the resident's own report of the condition. The facility also failed to carry out recommendations from specialty physicians for a resident with heart failure and COPD. Orders from a nephrologist to log and fax blood pressures, and from an oncologist to complete specific lab work, were not documented as completed. Additionally, the administration of midodrine for this resident did not consistently follow the ordered blood pressure parameters, with doses given when blood pressure was above the specified threshold and some doses held without documentation of blood pressure readings. These failures were confirmed by interviews with the Director of Nursing, who acknowledged the deficiencies and lack of documentation.