Failure to Notify Providers of Resident Refusals of Care and Services
Penalty
Summary
Facility staff failed to notify the appropriate medical provider regarding refusals of care and services for two residents. One resident, with diagnoses including Parkinson's disease, heart failure, and dementia with depression and anxiety, was noted to refuse medications most days. The care plan identified behavioral issues such as refusal of medications and ADL care, but the Psychiatric-Mental Health Nurse Practitioner (PMHNP) was not informed of the resident's ongoing nonadherence to prescribed psychiatric medications. During an interview, the PMHNP stated he was unaware of the medication refusals and had not been notified, despite considering medication adjustments. The PMHNP also observed significant cognitive decline and behavioral symptoms during his visit. Another resident, with diagnoses including muscle weakness, major depressive disorder, and seizures, frequently refused ADL and incontinent care. Although the refusal was sometimes reported to the physician and family, staff interviews revealed that the physician was not notified every time the resident refused care. The resident's refusals were care-planned, and the nurse practitioner was aware of the behavior but not consistently informed of each refusal. Observations included a strong urine odor in the resident's room and soiled bedding, indicating ongoing refusal of care.