Failure to Follow Physician Orders for Appointments and Lab Work
Penalty
Summary
The facility failed to follow physician orders regarding doctor's appointments and lab work for four out of five residents reviewed. Facility policy requires that residents receive treatment and care in accordance with professional standards, care plans, and resident choices. However, documentation and interviews revealed that residents did not receive scheduled medical appointments or required laboratory tests as ordered by their physicians. One resident with anxiety disorder and depression was unable to attend scheduled drug and alcohol treatment center appointments, resulting in the facility sending her to the hospital for medication, which caused her distress and embarrassment. Another resident with renal insufficiency and dementia missed scheduled hemodialysis sessions, leading to a hospital admission due to missed dialysis. A third resident with dementia and lung cancer had physician orders for blood tests (CMP and CBC) that were not completed, and a fourth resident with hyponatremia, Parkinson's disease, and hyperlipidemia had orders for weekly sodium level monitoring and lab results to be faxed to nephrology, but the clinical record did not show that these labs were performed. Interviews with the Nursing Home Administrator and Director of Nursing confirmed that lab work had not been completed for approximately four weeks, following the cessation of services from a contracted lab provider. The facility also acknowledged difficulties in sending residents to required external appointments, such as dialysis and drug treatment programs, resulting in non-compliance with physician orders for multiple residents.