Failure to Administer Hospice-Ordered Nutrition and Pain Management Therapies
Penalty
Summary
The facility failed to provide care and services as ordered by a hospice physician for a resident with a history of a displaced intertrochanteric fracture of the left femur and dysphagia, who was admitted with moderate cognitive impairment and required significant assistance with mobility. The facility did not include an order for Boost, a nutritional supplement, in the resident's active orders, despite it being present on the hospice agency's treatment list. There was no documentation that the Boost order was discontinued or placed on hold, and the omission was confirmed by nursing staff. The resident experienced a notable weight loss over a short period, and the care plan indicated the resident was on hospice for expected weight loss and overall decline. Additionally, the facility failed to include an order for diclofenac sodium topical gel, prescribed for osteoarthritis pain management, in the resident's drug therapy orders. The omission was identified during a review of the hospice agency's treatment list and confirmed by the MDS nurse. The resident, who had dementia and may not have been able to verbally report pain, was observed guarding the affected leg, which could indicate pain. The medication administration record showed the resident received morphine sulfate for severe pain on multiple occasions, but there was no evidence that the diclofenac was administered as ordered. Facility policy required coordination with hospice to meet the resident's care needs, including administering prescribed therapies.