Breakdown in Physician Communication and Collaboration for Resident with Complex Medical Needs
Penalty
Summary
The facility failed to ensure continuous communication and collaboration among multiple physicians involved in the care of a resident with complex medical needs, including squamous cell carcinoma, open wounds, and dementia. The resident was under the care of an Attending Physician, a Wound Care Specialist, a Dermatologist, and an Oncologist at various times, but there was a breakdown in communication regarding who was responsible for the resident's overall medical management. Documentation and interviews revealed that the Wound Care Specialist discontinued involvement after learning the Dermatologist was managing the case, but this change was not clearly communicated to nursing staff or reflected in the resident's care orders. As a result, nursing staff assumed the Wound Care Specialist was still overseeing wound care, while the Attending Physician and DON believed the Oncologist was managing the resident's cancer and related wounds. The resident's medical records showed inconsistencies in wound documentation, pain assessments, and care planning. The Minimum Data Set (MDS) assessments did not consistently indicate the presence of open lesions or pain, despite clinical observations and physician notes describing significant wounds and cancerous lesions. Orders for wound care consults were present in the record, but there were gaps in actual wound care visits and unclear documentation regarding the discontinuation of wound care services. The lack of clear direction and coordination among the physicians led to confusion among nursing staff about who was responsible for wound care and pain management. Interviews with facility staff, including nurses and the DON, confirmed that there was a lack of awareness about changes in physician responsibility and ongoing confusion about the resident's care plan. The facility's Bioethics Committee was identified as the responsible party for the resident's care due to the absence of family, but this committee did not ensure effective communication and collaboration among the physicians. The facility's policy required the attending physician to participate in assessment and care planning, but this was not effectively implemented, resulting in a breakdown of communication and collaboration for the resident's overall medical management.