Failure to Provide Timely Podiatry Foot Care for Diabetic Resident
Penalty
Summary
A resident with diabetes mellitus, peripheral vascular disease, diabetic neuropathy, and a history of right below-knee amputation was not provided timely foot care, specifically toenail care, after multiple requests were made by the resident’s health care agent and palliative care nurse practitioner. Despite documented recommendations from the nurse practitioner in the resident’s medical record over several months to add the resident to the facility’s podiatry list, there was no evidence that the resident was referred to or seen by the podiatrist during scheduled visits in the facility. The facility’s own policy required that residents with medical conditions associated with foot complications be referred to qualified professionals and assisted with appointments as needed. Interviews with facility staff, including the ADON and DON, revealed a lack of awareness regarding the repeated recommendations for podiatry care for this resident. The resident’s consent for a podiatry consult was not obtained until several months after the initial requests, and the first documented podiatry visit and treatment occurred only after a significant delay. At the time of the podiatry visit, the resident’s toenails were found to be elongated, dystrophic, discolored, mycotic, thick, yellow, lytic, and required debridement, indicating prolonged lack of appropriate foot care.