Failure to Follow Physician Orders and Professional Standards of Care
Penalty
Summary
The facility failed to provide care and services in accordance with professional standards and physician orders for four residents. For one resident with dementia, laboratory tests including a complete blood count, metabolic profile, lipid panel, hemoglobin A1C, and anticonvulsant drug levels were ordered to be performed every six months starting on a specific date, but there was no evidence these labs were obtained or results documented. The Nursing Home Administrator confirmed the labs were not completed as ordered. Another resident with dementia, hypertension, and atrial fibrillation had a consultant pharmacist's recommendation for digoxin drug level monitoring, basic metabolic profile, and daily pulse checks, which was signed by the provider. However, there was a delay of approximately nine weeks before the pulse monitoring order was implemented, and no order for a digoxin level was found in the clinical record. The Director of Nursing confirmed that these interventions should have been implemented when the recommendation was signed. A third resident with cerebrovascular disease and major depressive disorder had physician orders and care plan interventions for weekly skin assessments due to risk of skin breakdown. Documentation showed that several weekly skin assessments were missing over a three-week period. Additionally, a resident with diabetes and anxiety disorder had orders for twice-daily blood glucose checks with physician notification required for results above 400 or below 60. The Medication Administration Record showed multiple instances of blood glucose readings above 400, but there was no documentation that the physician was notified as required.