Failure to Obtain and Implement Physician Orders for Antifungal Treatment
Penalty
Summary
The facility failed to obtain and act upon Office Visit Summaries from outpatient physician visits for a resident, resulting in a lapse in prescribed treatment for onychomycosis (toenail fungus) of both great toes. The resident, who had a history of type 2 diabetes and moderate cognitive impairment, was under ongoing care for toenail fungus, with orders from an outside podiatrist to continue Ciclopirox 8% External Solution for an extended period. Despite these orders, the facility did not secure timely documentation from the podiatrist visits on two occasions, leading to a gap in the resident's treatment regimen. Observations and record reviews revealed that the resident's toenails remained thick and discolored, and the resident experienced emotional distress and depression related to the condition. Progress notes indicated that family members raised concerns about the toenails, and the wound care specialist confirmed the diagnosis of onychomycosis. Although the podiatrist provided clear instructions to continue the antifungal treatment, the facility did not maintain current orders for the medication, and the treatment was not administered for approximately two months. Interviews with facility staff, including the treatment nurse, Assistant Director of Nursing, and Director of Nursing, confirmed that there was confusion and lack of awareness regarding the process for obtaining and following up on Office Visit Notes. The Office Visit Summaries were not present in the resident's chart in a timely manner, and staff were unaware that the orders for Ciclopirox 8% had lapsed, resulting in the resident not receiving the prescribed treatment. The delay in obtaining and implementing physician orders led to a failure to provide appropriate care as directed by the resident's physician.