Failure to Implement Physician-Ordered Care Plan Interventions
Penalty
Summary
A deficiency occurred when the facility failed to implement care plan interventions for a resident with End Stage Renal Disease and Obstructive Sleep Apnea. The resident was dependent on staff for bed mobility and transfers and had an intact cognition. The care plan included interventions for oxygen via nasal cannula at 3 LPM as needed and a 1500 ml fluid restriction, with specific allocations for dietary and nursing staff, due to edema, diuretic use, and hospital dietary orders. However, a review of the current physician's orders revealed that there were no orders for either the fluid restriction or oxygen for this resident. Interviews with facility staff confirmed that the fluid restriction was entered into the care plan without a corresponding physician's order, despite it being a standard practice for dialysis patients. The Registered Dietitian stated that a physician's order should have been obtained before including the intervention in the care plan. The DON was unsure why the oxygen intervention was included and acknowledged that it was not supported by a physician's order, even though it was communicated on the admission notice form. The facility's care plan policy did not address the implementation of interventions.