Failure to Implement Audiologist's Ear Wax Removal Recommendation
Penalty
Summary
The facility failed to follow up on an audiologist's recommendation for ear wax removal for a resident with hearing difficulties. The resident, who had a history of stroke and moderate cognitive impairment, was noted to have new verbal communication difficulties, including the need for commands to be repeated, not turning when spoken to, and difficulty understanding speech. Audiology assessments on two separate occasions documented that excessive, hardened ear wax in both ears prevented the completion of hearing tests and that the audiologist recommended contacting the resident's physician for a wax removal protocol. Despite these recommendations, a review of the resident's physician orders revealed that the audiologist's recommendations for ear wax removal were not implemented. Interviews with staff indicated that the audiology recommendations were received by nursing management, but there was no follow-up to ensure the provider was notified or that orders were obtained. The DON acknowledged receiving the recommendations but did not contact the provider until much later, and the social worker confirmed she only verified appointment completion without reviewing for nursing recommendations. Further interviews with the medical director and administrative staff confirmed that the physician was not made aware of the audiology recommendations and would have ordered the treatment if notified. The responsibility for reviewing and acting on the audiology recommendations was attributed to nursing management, but there was a lack of communication and follow-through, resulting in the resident not receiving the recommended ear wax removal treatment.