Failure to Follow Physician Orders for Medication Administration and Consult Recommendations
Penalty
Summary
The facility failed to follow physician's orders regarding medication administration for multiple residents. For one resident with severe cognitive impairment and insulin-dependent diabetes, staff administered Insulin Lispro on numerous occasions when the resident's blood glucose was below the threshold specified in the physician's orders. The orders clearly stated that insulin should be held if blood glucose was less than 110 mg/dl, but the medication was given repeatedly when readings were below this level, as documented in the Medication Administration Record. The Director of Nursing confirmed that insulin was not administered as ordered on the specified dates. Another resident, who was cognitively intact and had a diagnosis of prostate cancer, returned from a radiology oncology/urology appointment with a recommendation for Bactrim DS to treat a urinary tract infection. The consult note indicated that the antibiotic should be started and adjusted based on culture results. However, there was no documented evidence that the facility obtained or acted upon these recommendations in a timely manner. The consult note was not sent to the facility until several days after the appointment, and the Director of Nursing confirmed that the consult sheet with the antibiotic recommendation was not received or acted upon promptly. A third resident, who was cognitively impaired and had a history of stroke with dysphagia, was prescribed metoprolol tartrate with instructions to hold the medication if blood pressure was less than 130/80. Despite this, the Medication Administration Record showed that the medication was administered multiple times when the resident's blood pressure was below the specified threshold. The Director of Nursing confirmed that the medication was given when it should have been held according to the physician's orders.