Failure to Administer Prescribed Antifungal Medication for Toenail Fungus
Penalty
Summary
The facility failed to follow a physician's order for a resident who was under the care of a podiatrist for onychomycosis (nail fungus) of the great toes. The resident, who had a history of type 2 diabetes and moderate cognitive impairment, was prescribed Ciclopirox 8% nail lacquer to be applied daily to the affected toenails. Despite ongoing orders from the podiatrist to continue this treatment for six months to one year, the medication was not administered to the resident for a period of two months. Observations revealed that the resident's right and left great toes appeared thick and discolored, and the resident reported pain and emotional distress related to the condition of her toenails. Multiple office visit notes from the podiatrist documented the need for continued application of Ciclopirox 8% and highlighted the lack of improvement in the resident's condition. However, the treatment nurse confirmed that the resident had not been receiving the medication for some time, and the Assistant Director of Nursing acknowledged that the orders for Ciclopirox 8% were not present in the resident's chart and had not been implemented since mid-July. The delay in obtaining and reviewing the podiatrist's office visit notes contributed to the failure to transcribe and carry out the physician's orders in a timely manner. The facility's staff, including the ADON and DON, recognized that the absence of the medication order and the lack of follow-through on the podiatrist's recommendations resulted in the resident not receiving the prescribed treatment for her toenail fungus.