Failure to Obtain Timely Practitioner Signatures on Monthly Orders
Penalty
Summary
The deficiency involves the facility’s failure to ensure that practitioners reviewed, signed, and dated physician orders at each required visit in accordance with Connecticut General Statute 19-13-D8t. For one resident with dementia and bipolar disorder who had severely impaired cognition and was receiving routine antipsychotic medication, the care plan identified risk for complications related to psychotropic drugs and included interventions such as gradual dose reduction and monitoring for side effects. However, review of provider orders showed that monthly orders were last signed by an APRN in mid-June, with no signed orders identified for July, August, November, or December. Another resident with dementia and hypertension, also with severely impaired cognition and receiving routine antipsychotics, had a care plan directing that medications be administered as ordered, but provider orders were only signed in mid-October, with no signed orders identified for November or December. A third resident with type II diabetes and schizophrenia, with moderately impaired cognition, was receiving routine antipsychotics and insulin injections, and had a care plan directing that medications be administered as ordered by the physician. For this resident, monthly orders were last signed in late September, with no signed orders identified for October, November, or December. A fourth resident with schizophrenia and hyperlipidemia, with moderately impaired cognition and receiving routine antipsychotics, had a care plan that included explaining the importance and risks of taking or not taking medications, but provider orders were only signed in late September, with no signed orders identified for October, November, or December. In an interview, the DNS stated that monthly orders are reviewed and signed in the medical records, that practitioners or the physician can sign off on resident orders, and that there was no facility policy for timeliness of signing orders, with the facility following a practice of signing orders every 60 days per the Connecticut Public Health Code.
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