Failure to Inform Cognitively Capable Resident of New Antiviral Prophylaxis
Penalty
Summary
The deficiency involves the facility’s failure to ensure a cognitively capable resident was informed of and allowed to participate in decisions regarding a new medication order. The resident was an older male with a history of cerebral infarction and resulting hemiplegia/hemiparesis, with a quarterly MDS BIMS score of 12 indicating moderate cognitive impairment. His face sheet and POA documents identified two family members as financial POA only, with no medical decision-making authority or MPOA designation. The resident’s care plan noted risk for impaired cognitive function, but staff interviews consistently described him as able to consent to his own treatment, oriented, and able to recognize people and express his needs. Record review showed that on a January date, the resident was exposed to influenza A in the facility and, per protocol, was started on oseltamivir (Tamiflu) 75 mg orally once daily for influenza A prophylaxis for 14 days, ordered by the in-house provider. A nursing progress note documented that the responsible party was notified and approved the medication, but there was no documentation from the NP, ADON, LVN, or any other staff that the resident himself was informed of the new medication or its purpose between the start of therapy and the survey date. The resident’s immunization record showed he had already received an influenza vaccine earlier in the season, and there was no indication in the chart that he had been found incompetent by a court of law, as referenced in the facility’s resident rights policy. During interviews, the resident stated he was started on “flu medication” and did not learn what it was for until about three days later, after a family member asked if he knew he had been started on Tamiflu and told him the facility had contacted another family member for permission. He stated that he was not “crazy,” could still make his own decisions, and wanted the facility to contact family only if he was unable to decide for himself. He reported that no one came to ask him about starting the medication or whether he wanted to take it. Multiple staff members, including an LVN, RN, ADON, DONs, and the administrator, described that residents should be notified of new medications and that this should be documented, and several acknowledged that this was important for resident autonomy and involvement in care. However, the LVN could not recall if this resident was notified, the ADON stated the nurse or NP was responsible for speaking with residents, and the DON later asserted that the NP had notified this resident, despite the absence of documentation and the resident’s statement that he had not been informed in advance.
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