Failure to Follow Physician Orders and Complete Clinical Monitoring for Resident with Loose Stools
Penalty
Summary
A deficiency occurred when a resident with multiple medical conditions, including diabetes, morbid obesity, and a dehisced amputation stump, experienced ongoing loose stools for several days. Despite repeated documentation of loose bowel movements and ineffectiveness of prescribed Imodium, there was no evidence that clinical monitoring or laboratory tests for Clostridium Difficile, as ordered by the nurse practitioner, were initiated. Additionally, the resident's care plan required monitoring of labs and reporting of abnormal findings, but there was no documentation that these actions were taken. Physician and nurse practitioner progress notes indicated plans to order stool tests for Clostridium Difficile, start Metamucil, and monitor the resident clinically. However, the electronic medical record did not show that these orders were processed or that the tests were completed. The medication administration record also revealed that Docusate Sodium, which was to be held for loose stools, continued to be administered on multiple days when the resident had loose stools, contrary to physician orders. There was also no evidence that Metamucil was ordered or started as planned. The resident's condition deteriorated, with increasing lethargy and slurred speech, leading to further orders for laboratory tests, intravenous hydration, and a chest x-ray. Despite these orders, there was no documentation that the laboratory tests or chest x-ray were completed. The resident was eventually transferred to the hospital and diagnosed with septic shock. Interviews with staff confirmed that orders were given verbally but not processed, and the nurse practitioner acknowledged that the lack of completed laboratory tests prevented diagnosis and treatment, resulting in actual harm to the resident.