Medication, Lab Reporting, Assessment, and Appointment Scheduling Deficiencies
Penalty
Summary
Multiple deficiencies were identified involving the care and treatment of several residents. One resident with a history of peripheral vascular disease, hypertension, diabetes, and obstructive pulmonary disease was dependent for activities of daily living and required a fluticasone-salmeterol inhaler twice daily. The medication was not available for administration on several days, and although a refill was called in and delivered, it was not administered until two days after delivery. Staff could not provide a reason for the delay in reordering or administering the medication. Another resident with chronic obstructive pulmonary disease and a history of deep vein thrombosis was prescribed weekly Protime and INR lab tests due to anticoagulant therapy. The resident's INR result was significantly elevated, but there was no evidence that this result was reported to the physician as required by facility policy. Both the physician and LPN confirmed they were not notified of the abnormal result, and the physician stated that, had he been notified, he would have adjusted the resident's medication regimen. A third resident was admitted with a widespread fungal infection and had an order for a dermatology appointment. The appointment was not scheduled for 13 days after the order was written, and there was no documentation of attempts to schedule it during that period. Additionally, another resident admitted for osteomyelitis and with a PEG tube did not have vital signs documented upon admission, nor was the PEG tube checked for patency as expected. The PEG tube was found to be non-functional only after several hours, resulting in the resident being sent to the hospital. The required hospital observation assessment was not completed until several days after the resident's transfer.