Failure to Provide Ordered Care and Ensure Specialist Referrals
Penalty
Summary
The facility failed to provide necessary care and treatment according to physician orders and residents' needs for two residents. For one resident, documentation showed prolonged periods without a bowel movement, specifically nine days and six days on separate occasions. Despite physician orders for as-needed administration of Milk of Magnesia and Dulcolax suppositories if no bowel movement occurred in three days, there was no documentation that these interventions were offered or administered during the periods of constipation. The Director of Nursing confirmed that no interventions were documented as provided during these times. For another resident, the facility did not ensure that specialist referrals and diagnostic procedures were scheduled or completed as ordered by the physician. The resident had a persistent, non-healing neck wound with ongoing concern for malignancy, and multiple referrals to dermatology and an MRI were ordered. However, there was no documentation that the dermatology appointment or MRI was scheduled or completed, and the resident missed several specialist appointments, often due to lack of transportation or appointments not being made. The medical record repeatedly noted the need for specialist evaluation and follow-up, but these were not carried out as ordered. Interviews with facility staff, including the Director of Nursing and a Nurse Practitioner, confirmed the lack of documentation and follow-through on physician orders for both residents. The deficiencies were identified through record review and staff interviews, which revealed failures in providing care and ensuring timely access to necessary medical services as ordered.