Failure to Follow Provider Orders and Facility Protocols for Medication and Treatment Administration
Penalty
Summary
The facility failed to provide appropriate treatment and care according to provider orders and facility policy for several residents. For one resident with a history of abdominal pain and no bowel movement for 11 days, the facility did not follow its bowel protocol, which required specific interventions at set intervals without a bowel movement. The resident did not receive the ordered Polyethylene glycol until five days after it was prescribed, and there was no documentation of bowel movements or administration of PRN interventions such as Milk of Magnesia, Bisacodyl suppository, or Fleets enema as outlined in the facility's policy. Additionally, the facility did not implement provider orders as written for multiple residents. One resident was admitted and had several medication orders, but there was no evidence that these medications were started upon admission as required, and there was no directive from the hospital or pharmacy to delay administration. Another resident with a diagnosis of Major Depressive Disorder had an order for escitalopram that was not started for several days after the provider's order, and the provider noted the delay in the resident's follow-up visit. Similarly, a resident with an order to change a muscle relaxant from routine to PRN did not have the order changed until four days after the provider's instruction. Further deficiencies were noted in the administration of ear care for a resident with otitis media. The resident was ordered to receive carbamide peroxide ear drops followed by irrigation, but the orders were entered incorrectly, and the treatment was not completed as prescribed, resulting in the need for the provider to reorder the treatment. Another resident with Major Depressive Disorder had their fluoxetine discontinued without documented reason, then received a one-time dose, and the medication was later re-entered, with the Regional Nurse Consultant confirming the discontinuation was in error. These failures demonstrate a pattern of not following provider orders and facility protocols for medication and treatment administration.