Failure to Implement Physician Orders and Adhere to Professional Standards
Penalty
Summary
The facility failed to meet professional standards of quality for three residents by not implementing physician's orders and not adhering to established nursing practices. For one resident with dysphagia, the nurse administered aspirin dissolved in applesauce and followed it with unthickened apple juice, despite orders specifying that only moderately thick liquids should be given. The speech therapist and Director of Nursing confirmed that the resident should not have received thin liquids, and the nurse admitted to not thickening the juice as required. Another resident with peripheral vascular disease and severe cognitive impairment had a physician's order for a Prevalon boot to be worn on the right lower extremity at all times as tolerated. Multiple observations showed the resident was not wearing the boot during various activities and times of day, even though the treatment administration record indicated otherwise. Staff interviews revealed that the resident did not refuse care, and there was no documentation of refusal or behavioral issues. The Assistant Director of Nursing and Director of Nursing both stated that physician's orders should be followed and verified by staff. A third resident, who was cognitively intact but required supervision for daily activities, was found with a medication cup containing partially disintegrated pills left at the bedside. The nurse had left the medication with the resident while the resident was getting dressed, without a physician's order or care plan for self-administration. Facility policy and staff interviews confirmed that medications should not be left with residents unless there is a specific order and assessment for self-administration. The Director of Nursing reiterated that nurses are to stay with residents to ensure medications are taken as ordered.