Failure to Follow Physician Orders for Medication and Therapy Evaluation
Penalty
Summary
The facility failed to ensure that residents received care and treatment in accordance with professional standards of practice by not following physician's orders for medication administration and therapy evaluations. For one resident with end-stage renal disease (ESRD) receiving hemodialysis, there was no documented evidence that multiple prescribed medications, including antihypertensives, antidepressants, blood thinners, and dietary supplements, were administered as ordered either prior to or after dialysis sessions on numerous specified dates. The care plan and physician's orders clearly indicated the need for medication administration in relation to dialysis, but the Medication Administration Records did not reflect that these orders were followed. Another resident, also with ESRD and Parkinson's disease, had similar deficiencies in medication administration. The records showed that several doses of prescribed medications, including midodrine, methocarbamol, and carbidopa-levodopa, were not documented as given before or after dialysis on multiple occasions. The care plan for this resident also specified the importance of medication timing in relation to dialysis, but staff failed to document administration as required. The DON confirmed that there was no evidence these medications were given as ordered and acknowledged that the timing of doses was not clarified with the physician when concerns arose. Additionally, the facility did not follow through on a therapy screening ordered for one resident after an orthopedic consult. Although the order for a therapy screen was present in the clinical record, and the resident had previously received therapy services, the required screening was not completed. The Director of Rehabilitation and the DON both confirmed that the therapy screen was not conducted as ordered.