Failure to Notify Physician and Representative of Repeated Medication Refusals
Penalty
Summary
Facility staff failed to notify the resident's representative and physician of multiple medication refusals by a resident with diagnoses including dementia, heart failure, and diabetes mellitus. The resident, who had severely impaired cognition and required significant assistance with daily activities, was prescribed several medications to manage diabetes, including Glipizide, Humalog insulin, and Lantus insulin. The Medication Administration Record showed frequent refusals of these medications, particularly insulin, with some medications refused up to 22 out of 24 opportunities. Despite these repeated refusals, there was no documentation in the nursing progress notes indicating that the resident's representative or medical provider had been notified. Interviews with facility staff revealed inconsistent practices regarding notification of medication refusals. Some staff stated they would notify nursing management or the medical provider after more than one refusal, while others relied on verbal notifications or attempted to document notifications in the medical record. The Director of Nursing Services confirmed that notifications should have been made for these refusals, especially for medications with significant health impacts. The resident was subsequently admitted to the hospital for hyperglycemia and altered mental status, and the resident's representative reported being unaware of the extent of the medication refusals prior to the hospitalization.