Failure to Notify Physician of Missed TPN Dose
Penalty
Summary
The facility failed to notify a resident's physician of a missed dose of total parenteral nutrition (TPN) for a resident who was dependent on intravenous nutrition due to an intestinal blockage and was on a NPO (nothing by mouth) diet. The resident was admitted for TPN therapy and had multiple diagnoses, including intestinal blockage, intestinal fistula, colon cancer, hypertension, and chronic kidney disease. On the date in question, the Medication Administration Record indicated that the TPN was not administered, and nursing progress notes confirmed the missed dose, citing the need for an RN to administer the medication and that the on-call nurse was aware. Interviews with staff revealed that there was confusion regarding responsibility for clarifying TPN orders and administration, with LPNs directed to consult with RNs, and RNs expected to clarify orders with the physician or pharmacy. Despite these communications, there was no documentation that the resident's physician was notified of the missed TPN dose, as required by facility policy. The Director of Nursing confirmed that the physician was not informed of the missed dose, and the facility's policy mandates prompt notification of the physician in such situations.