Failure to Implement Physician Orders for Dental, Podiatry, and Drug Testing Services
Penalty
Summary
The facility failed to provide care and services in accordance with professional standards of practice for a resident by not implementing physician's orders for dental and podiatry services, and by not clarifying and carrying out a neurologist's order for drug testing. The resident, who had diagnoses including dementia, schizoaffective disorder, major depressive disorder, diabetes mellitus, and anxiety, was moderately cognitively impaired and required moderate assistance with activities of daily living. Physician orders for dental and podiatry consultations were in place, and care plans indicated the need for these services, but there was no documented evidence that the resident received either service since readmission. During observation, the resident was found to have long, irregular toenails with debris and reported discomfort, expressing a need to see a podiatrist. The resident also reported tooth discomfort and a need for dental evaluation. The responsible party confirmed that the resident had not been seen by a podiatrist or dentist since readmission and expressed concern about the lack of follow-through on these services. Social Services staff confirmed that they were responsible for arranging such services and acknowledged that no appointments had been made, placing the resident at risk for foot discomfort, infection, and worsening dental pain. Additionally, a neurologist's order for weekly drug testing was not clarified or implemented. The nurse attempted to clarify the order by contacting the neurologist's office but did not follow up after leaving a message, and no drug testing was performed. Facility policy required that unclear orders be clarified and documented, and that outside services be coordinated as ordered by the physician, but these procedures were not followed in this case.