Failure to Provide Follow-Up Care and Treatment for Chronic Hepatitis C
Penalty
Summary
The facility failed to provide services according to acceptable standards of practice for a resident diagnosed with chronic hepatitis C. Upon admission, the resident had a documented diagnosis of chronic viral hepatitis C, with previous recommendations for follow-up at a hepatitis clinic and coordination with a physician regarding a medication regimen. Despite these recommendations and the presence of active infection as indicated by lab results, there was no evidence in the resident's medical record that a referral to a hepatitis clinic was made or that orders for hepatitis C treatment were initiated. Further review of the resident's care plan and medical records revealed that while the care plan acknowledged the hepatitis C diagnosis and outlined approaches such as administering medications as ordered and monitoring for symptoms, there was no documentation that the necessary labs ordered by the ARNP were obtained. Additionally, subsequent history and physical notes failed to list hepatitis C as an active or past medical concern, and there was no follow-up on abnormal lab findings or the need for hepatitis C treatment. The resident's condition progressed to cirrhosis and hepatocellular carcinoma, as documented in hospital and hepatology clinic records. Interviews with facility staff, including an LPN and the DON, indicated a lack of awareness regarding the resident's hepatitis C status and the required follow-up actions. The DON confirmed that there was no standard procedure for ensuring ARNP and physician orders were consistently reviewed and acted upon, and was unaware of the CDC's updated guidance for hepatitis C testing. The absence of a clear process for order review and follow-up contributed to the failure to provide appropriate care and treatment for the resident's chronic hepatitis C.