Failure to Follow Physician Orders and Document Care for Bowel Management, Hospice, and Skin Conditions
Penalty
Summary
The facility failed to provide appropriate treatment and care according to physician orders, resident preferences, and goals in several key areas. For bowel management, multiple residents experienced extended periods without bowel movements, yet staff did not administer as-needed (PRN) bowel medications as ordered. For example, one resident went up to 12 shifts without a bowel movement on several occasions, with no PRN medication given, despite clear orders to administer medications after three days without a BM. Similar failures were observed for other residents, including those with severe cognitive impairment and those on hospice, where the bowel protocol was not initiated or documented as required by facility policy and physician orders. In the area of hospice services, the facility did not maintain or document coordinated hospice plans of care for residents receiving hospice. For two residents on hospice, there was no evidence in the electronic health record (EHR) of a current hospice plan of care, hospice intake, terminal diagnosis, or documentation of hospice visits and services provided. Staff were unable to locate required hospice documentation, including the hospice plan of care, hospice election form, physician certification/recertification of terminal illness, and visit notes, either in the EHR or in hospice binders. This lack of documentation meant that staff could not determine what hospice disciplines were involved or the frequency of their visits. Regarding non-pressure skin monitoring, the facility did not routinely assess or monitor skin conditions or implement recommended interventions for a resident with self-inflicted abrasions and a generalized rash. Despite wound care consultant recommendations for specific treatments and monitoring, these were not implemented or documented in the MAR/TAR. There was no ongoing documentation or monitoring of the resident's skin abrasions, and staff confirmed that these issues were not tracked as required. The lack of assessment and follow-through on consultant recommendations contributed to the deficiency in skin care management.