Failure to Provide Resident-Directed Care and Timely Implementation of Physician Orders
Penalty
Summary
The facility failed to provide resident-directed care and services in accordance with professional standards of practice and consistent with physician orders for three residents. For one resident with depression and hypertension, there was a significant delay in scheduling an orthopedic consult for bilateral knee flexion contractures. Despite the resident's ongoing requests and a physician order to schedule a second opinion, the appointment was not scheduled for five months. Documentation showed that the referral was sent, but follow-up was not conducted in a timely manner, resulting in the resident waiting an extended period for the consult. Another resident with dementia, lack of coordination, and muscle weakness had a physician order for a gastroenterology (GI) consult that was not scheduled for several months. Additionally, laboratory orders for CBC, CMP, and urinalysis were not completed as ordered, with documentation indicating that some orders were not properly transcribed or scheduled. There was also a failure to implement and document blood pressure monitoring every shift as ordered by the nurse practitioner, with no blood pressure readings recorded for an extended period despite an active order. A third resident with hyperlipidemia and hypertension did not receive medications as ordered, including Ambien, Patiromer Sorbitex Calcium, and Fondaparinux Sodium, on specific dates. The Medication Administration Record (MAR) was left blank or coded as held, and there was no evidence that the physician was notified of the missed doses. Interviews and documentation revealed that medications were either not available, not located, or not administered as scheduled, and staff did not follow facility policy regarding documentation and physician notification for missed or delayed doses.