Failure to Monitor Anticoagulant Therapy and Delay in Infectious Disease Consult
Penalty
Summary
The facility failed to provide appropriate care and services for two residents by not ensuring proper monitoring and follow-up as required by physician orders and care plans. For one resident with a history of atrial fibrillation, sepsis, and deep vein thrombosis, the care plan required monitoring for complications related to anticoagulant therapy, specifically for signs of bleeding. Despite documented episodes of blood in the urine and a known drug interaction between amiodarone and apixaban that increases bleeding risk, there was no evidence in the Medication Administration Record (MAR) that bleeding monitoring was performed or documented during the relevant period. Nursing staff confirmed that such monitoring should have occurred and was not documented. Another resident with recurrent urinary tract infections (UTIs), paraplegia, and anxiety disorder had a physician's order for an infectious disease consult due to a diagnosis of a multi-drug resistant organism (MDRO) in the urine and ongoing UTIs. Although the infectious disease doctor was notified of the need for a consult, there was a delay of over a week before the facility followed up on the appointment. During this time, the resident did not receive antibiotics for the current UTI and experienced bladder spasms, pain, and anxiety about the infection worsening. Nursing staff and the Director of Nursing acknowledged the delay in follow-up for the infectious disease consult. Both cases demonstrate a failure to provide care and services in accordance with physician orders, care plans, and resident needs. The facility's own policy requires that residents receive necessary care and services to attain or maintain their highest practicable well-being, but this was not achieved for these two residents due to lapses in monitoring and timely follow-up.