Failure to Follow Physician Orders for Orthostatic Blood Pressure and Medical Appointments
Penalty
Summary
The facility failed to ensure that services provided met professional standards of quality by not following physician's orders for two residents. For one resident with Parkinson's disease, a history of falls, and on antipsychotic medication, the physician had ordered orthostatic vital signs to be taken every three months. The resident experienced multiple episodes of dizziness and falls, and a quarterly assessment revealed a significant drop in orthostatic blood pressure. However, there was no evidence that the provider was notified of this change, despite staff and the nurse practitioner stating that such changes should be reported. For another resident with spinal stenosis and neurogenic bladder dysfunction, the physician ordered a urology consult for possible suprapubic tube placement and an MRI of the spine. The resident expressed interest in the procedure, and the physician documented the need to schedule the appointments. Despite this, there was no evidence that either the urology or MRI appointments had been scheduled. Staff interviews confirmed that the appointment scheduler was unaware of the orders, and the LPN stated that no appointments had been made. In both cases, the facility did not follow through on physician's orders, either by failing to notify the provider of significant clinical changes or by not scheduling required medical appointments. These actions resulted in a failure to provide appropriate treatment and care according to the residents' needs and physician directives.