F0755

D

Delayed Initiation and Missed Doses of Post-Surgical Antibiotic

Haines City, Florida Survey Completed on 01-13-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to timely initiate and consistently administer a prescribed antibiotic for one resident following an orthopedic surgical procedure. The resident, who had diagnoses including CVA with hemiplegia, diabetes, stage III chronic kidney disease, hypertension, and Alzheimer’s disease, required substantial to maximal assistance with ADLs and was rarely or never understood per the MDS. On 12/12/25, an orthopedic office called with new post-surgical treatment orders, including Tramadol 50 mg every 8 hours as needed and Cephalexin 500 mg four times daily for 10 days. A progress note documented these new orders and indicated the facility was awaiting the resident’s return. However, the Cephalexin order was not entered into the physician orders on 12/12/25, and the medication was not started until 12/13/25 with only the 5 p.m. and 9 p.m. doses administered that day, resulting in two missed doses on 12/13/25.

Further record review showed that on 12/14/25, the 9 a.m. Cephalexin dose was held while awaiting MD approval due to the resident’s penicillin allergy, and the resident did not receive that 9 a.m. dose, resulting in a total of five missed or delayed doses across the period reviewed. Progress notes showed Cephalexin 500 mg QID post-surgical for 10 days was entered on 12/13/25 at 2:29 p.m., and on 12/14/25 at 8:16 a.m. staff documented they were awaiting MD approval to administer due to allergies. The resident’s care plan identified impaired cognitive function related to CVA with an intervention to administer medications as ordered. During interview, the LPN/Unit Manager stated that the resident usually went with family for procedures, that staff had been unable to locate any paperwork from the orthopedic doctor, and acknowledged that staff had depended on the family for orders instead of obtaining them directly from the physician. The LPN/Unit Manager also stated she wrote the note about the antibiotic order on 12/12/25, gave the orders to the floor nurse, and acknowledged that the orders may not have been entered until the next day and that she should have entered them herself, verifying there was a delay in doses. Facility policies required that medications be administered as soon as practicable upon written order, that orders be recorded and transcribed into the electronic chart, and that medications be administered in accordance with prescribing orders and time limits.