Failure to Hold Antiplatelet Medication Resulting in Missed Dental Extractions
Penalty
Summary
The deficiency involves the facility’s failure to hold an ordered antiplatelet medication (aspirin) prior to a scheduled dental extraction, resulting in a resident being unable to receive planned dental services. The resident was admitted with severe protein-calorie deficiency and heart disease and had an active order for aspirin 81 mg at bedtime. He was care planned for dental health problems, including broken teeth, poor repair, tooth pain, and abscesses, and his MDS documented mouth or facial pain and discomfort with chewing. A dental extraction consent form, signed by the resident and the Medical Director, specified that because the resident was on a blood thinner, the medication needed to be held 24–48 hours prior to dental procedures, and that this order was valid for one year. Following this, the dentist documented that no remaining teeth were restorable and that a full mouth extraction was planned. A physician’s order was written and implemented in October to hold the aspirin for several days, and the resident successfully had four teeth extracted at that time. The social worker reported that after the October visit, the dentist scheduled the resident for additional extractions at the next clinic visit in November and that she informed the former DON of this upcoming extraction. However, there were no physician’s orders to hold aspirin in November, and the MAR showed the aspirin was not held on the days preceding or on the date of the scheduled November dental visit. On that date, the dentist documented that the resident could not be seen because the blood thinner had not been held and that he would be seen at the next visit if the medication was held. The resident reported ongoing intermittent tooth pain, especially with tougher foods, and confirmed that the November appointment was canceled because his medication had not been stopped beforehand. The former DON acknowledged that the consent form, which included the standing order to hold blood thinners for one year, had been scanned into the chart but was missed by nursing staff, who were looking for a new order and were not aware of the dentist’s return date.
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