Failure to Complete Treatments as Ordered and Timely Address Medication Allergy
Penalty
Summary
The facility failed to provide appropriate treatment and care according to physician orders and failed to timely address a medication allergy for three residents. One resident with a history of urinary tract infections (UTIs) experienced a repeat allergic reaction to Bactrim, an antibiotic, after it was prescribed despite prior discussion of a possible allergy during a care plan meeting. The family reported swelling of the resident's lips after administration of Bactrim, with photographic evidence of similar reactions on two separate occasions. Documentation from the care plan meeting did not reference the allergy, and staff interviews revealed uncertainty and lack of documentation regarding the medication sensitivity discussed. The allergy was only formally documented in the resident's record after the most recent reaction occurred. Another resident with diabetes and skin impairments had a physician's order for foam dressing changes on specific days. The treatment was not completed on one occasion, with the reason documented as "not enough time." The nurse responsible indicated that due to time constraints during her shift, she was unable to complete all assigned treatments, including the required dressing change for this resident. The resident was cognitively intact at the time of the deficiency. A third resident with acute respiratory failure and chronic pulmonary edema had a physician's order for Profore two-step dressing changes to the lower extremities on scheduled days. The dressing change was not completed as ordered, with documentation indicating insufficient time or staff as the reason. Interviews with nursing staff confirmed that wound care tasks were delayed or missed due to workload, and the resident reported that his leg dressings were changed later than scheduled. Facility policy required adherence to physician recommendations for treatment, which was not followed in these instances.