Failure to Ensure Physician Completed Initial Comprehensive Visit
Penalty
Summary
A deficiency occurred when the facility failed to ensure that an initial comprehensive consultation was completed by a physician for one resident who was admitted with hypokalemia and required assistance with all activities of daily living. The resident was admitted and later transferred to the hospital, but the medical record review showed that the initial comprehensive visit was performed by a nurse practitioner, not the assigned physician, as required. There was no documentation of a written approval or recommendation by the physician for the resident's admission. Further review of the physician orders revealed that the physician signed an order agreeing with the care plans and diagnosis list only after the resident was no longer under the care of the facility. The facility's policy stated that a physician is responsible for the resident's first initial comprehensive visit. During interviews, facility leadership could not provide a timely or adequate explanation for the absence of the required physician documentation, and the only physician consult provided was completed after the nurse practitioner's initial visit.