Failure to Timely Implement Oncologist Recommendations
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a resident received appropriate treatment and care according to physician orders and consultation recommendations. The resident, who had multiple complex diagnoses including chronic pulmonary embolism, coronary heart disease, moderate pericardial effusion, and small cell carcinoma of the lung with superior vena cava syndrome, was seen by an oncologist who recommended stopping cyclobenzaprine, considering a reduction in olanzapine dosage, and starting dexamethasone. Although the olanzapine dosage was adjusted and dexamethasone was eventually ordered, there was no documented evidence that the attending physician was notified of the oncologist's recommendations in a timely manner following the initial consult. Nursing progress notes did not show that the medical doctor was informed of the oncologist's recommendations between the date of the consult and the date the orders were implemented. Interviews with staff revealed that the LPN who received the consult only reviewed it and notified a nursing supervisor, but did not recall notifying the physician. The RN supervisor was unaware of the recommendations and stated that unit nurses are responsible for reviewing consults. The physician confirmed that they were not notified until several days later, at which point the recommended medication was ordered. This delay resulted in the resident not receiving the prescribed dexamethasone as recommended by the oncologist.