Failure to Implement Physician Orders for Medication and Specialist Consult
Penalty
Summary
The facility failed to implement physician's orders for a resident who had been diagnosed with encephalopathy and cellulitis of the lower limbs. The resident, who had moderate cognitive impairment and required partial to moderate assistance with activities of daily living, developed a generalized body rash. The physician ordered hydrocortisone 1% cream to be applied daily for 30 days to treat dermatitis, but the Treatment Administration Record showed that the medication was not administered for several days following the order. Additionally, when the resident developed redness in both lower legs, the physician ordered a dermatology consult, but this order was not entered or implemented. Interviews with nursing staff confirmed that the orders for both the hydrocortisone cream and the dermatology consult were not transcribed or carried out as required. The Director of Nursing stated that all physician orders should be implemented on the day they are received, and facility policy requires licensed nurses to transcribe and implement orders promptly. Review of the resident's records and facility policies confirmed that these steps were not followed, resulting in the deficiency.