Failure to Follow Physician Orders for Medication and Wound Care
Penalty
Summary
The facility failed to ensure that services provided met professional standards of quality for two residents, specifically by not following physician orders for medication administration and wound care. One resident was admitted with multiple diagnoses, including heart failure, renal insufficiency, diabetes, anxiety disorder, and respiratory failure. Upon admission, the resident did not receive any of the prescribed evening medications, and there was no documentation that the physician was notified of the missed doses. The medication orders were not faxed to the pharmacy until later in the evening, resulting in a delay in medication delivery. The resident and a family member reported that medications were not administered and that the resident's oxygen tank ran out without timely replacement, prompting the resident to leave the facility against medical advice the following day. Another resident with a history of coronary artery disease, heart failure, and peripheral vascular disease had a care plan addressing the risk for pressure ulcer development and a chronic vascular ulcer on the right lower leg. The facility staff did not consistently follow wound care orders as written by the resident's provider, including the application of dressings and compression stockings. Observations and staff interviews revealed that wound care treatments were missed or performed incorrectly, with staff citing time constraints and lack of specific training. Documentation showed that the resident experienced increased edema, wound deterioration, and episodes of cellulitis, with inconsistent use of compression stockings and incorrect dressing applications. Multiple progress notes and interviews with external care providers indicated ongoing concerns about the facility's compliance with wound care orders. The facility's own policies required that physician orders be followed and that the DON or designee and physician be notified if orders could not be carried out. Despite this, there were repeated failures to adhere to prescribed treatments, and the DON and administrator acknowledged missed treatments and lack of staff education. The deficiencies were substantiated by clinical record reviews, resident and family interviews, pharmacy and staff interviews, and policy review.