Failure to Schedule Required Endocrinology Appointment for Resident
Penalty
Summary
A deficiency occurred when the facility failed to schedule a required endocrinology appointment for a newly admitted resident with diagnoses including Alzheimer's disease, type 2 diabetes mellitus, and myotonic muscular dystrophy. Upon admission, the resident was assessed as alert with good memory recall and required staff assistance for positioning and transfers. The care plan identified the resident as being at risk for hypo/hyperglycemia, and a physician's order directed that a follow-up appointment with endocrinology be scheduled within one to two weeks. However, review of the clinical record and medication administration records over a period of more than three months showed that the appointment was never scheduled, nor was the resident seen by endocrinology, despite daily documentation indicating the order remained active. Interviews with facility staff revealed that the process for scheduling outside appointments involved the charge nurse, who was responsible for making the appointment within 72 hours or notifying the nursing supervisor if unable to do so. The DON confirmed that nursing staff were responsible for scheduling such appointments and acknowledged that the order should have been followed. Despite this, the order remained unsigned for its intended purpose and was simply carried over daily for several months. No facility policies regarding following physician's orders or scheduling offsite appointments were provided upon request.