Failure to Obtain Physician Order for Hemoglobin Monitoring Prior to Epogen Administration
Penalty
Summary
The facility failed to ensure that a resident with end stage renal disease, chronic obstructive pulmonary disease, and anemia received treatment and care in accordance with professional standards of practice. Specifically, the facility administered Epogen injections for anemia without obtaining a physician's order for hemoglobin monitoring, as required by both the medication's manufacturer's guidelines and the facility's own policy. The resident's records showed that Epogen was given on multiple occasions, but there was no corresponding order or documentation for regular hemoglobin level checks prior to administration. Interviews with nursing staff and the Director of Nursing confirmed that there was no physician order for hemoglobin monitoring and that Epogen should not have been administered without this monitoring. The facility's policy required medication orders to include follow-up requirements such as repeat labs or therapeutic medication monitoring, which was not followed in this case. The manufacturer's guidelines for Epogen also specified weekly hemoglobin monitoring until stable, then at least monthly, to ensure safe administration.