Failure to Update and Follow Physician Orders After Oncology Appointment
Penalty
Summary
The facility failed to update and follow all physician orders after a resident's outpatient oncology appointment. The resident, who had diagnoses including iron deficiency anemia, malignant neoplasm of the breast, and secondary malignant neoplasms of the bone and bone marrow, was seen by an oncology nurse practitioner and doctor, who provided written orders to hold the chemotherapy medication Ribociclib for one week and to resume it on a specified date. The physician order sheet included instructions for weekly CBC, daily Letvozole, a specific start date for the next Ribociclib cycle, and an evaluation by radiation oncology. Despite these orders, the medication administration record showed that the resident continued to receive Ribociclib during the period it was supposed to be held. Interviews with facility staff revealed that the nurse responsible for the resident after the appointment did not enter all of the new physician orders into the system, only entering the order for weekly CBC. The nurse acknowledged not entering the order to hold Ribociclib, despite being aware of the written instructions. Another nurse attempted to administer Ribociclib during the hold period and was informed by the resident that it should not be given until the specified date. The facility's policy requires that all medication orders be documented and followed, but this was not done in this case, resulting in the resident receiving chemotherapy against the physician's orders.