Failure to Ensure Physician Order and Monitoring for Resident-Owned Medical Device
Penalty
Summary
The facility failed to ensure professional standards of practice were implemented for medication management for one resident. The resident, who was cognitively intact and admitted with lower extremity cellulitis and polyneuropathy, brought a Therma Zone pain management device into the facility and used it independently for joint pain. Observations confirmed the device was present and in use in the resident's room. However, there was no physician order for the device, no documentation or monitoring of its use in the Treatment Administration Record, and it was not included in the resident's care plan. Interviews with staff revealed that neither nursing assistants, LPNs, occupational therapy, nor the Resident Care Manager were aware of the device's presence or use. The Director of Nursing Services stated that facility policy requires a physician order, resident assessment, and maintenance inspection for any medical device brought in by a resident, but these steps were not followed. The deficiency was cited under WAC 388-97-1620(2)(b)(ii) for failure to obtain a doctor's order and monitor the use of resident-owned medical equipment.