Failure to Follow Physician Orders for Lab Monitoring and Specialist Consults
Penalty
Summary
The facility failed to provide nursing services consistent with professional standards of quality by not ensuring that licensed nurses properly evaluated and provided care according to physician orders for two residents. For one resident with atrial fibrillation and hypertension, there was a physician's order for warfarin therapy and regular PT/INR monitoring. Although a PT/INR test was ordered to be repeated in one week following a subtherapeutic result, there was no evidence that the required laboratory test was completed or that the result was available as ordered by the physician. For another resident with dementia, urine retention, and an indwelling Foley catheter, there were physician orders for urology consultation due to complications with the catheter and for follow-up with infectious disease after abnormal urinalysis and urine culture results. The clinical record did not show evidence that the required consults were called or that appointments were made, despite documentation of abnormal laboratory findings and physician awareness of these results. The resident later exhibited signs of infection and acute illness, leading to hospitalization for sepsis and renal failure. The deficiencies were confirmed through review of clinical records, facility policy, and staff interviews, which showed that nursing staff did not follow through with physician orders for laboratory monitoring and specialist consultations. Documentation was incomplete regarding the execution of these orders, and there was a lack of evidence that appropriate nursing actions were taken to ensure timely and adequate care as directed by the physicians.