Failure to Monitor Thyroid Function for Resident on Levothyroxine
Penalty
Summary
The facility failed to ensure a resident’s drug regimen was monitored appropriately by not obtaining thyroid function labs for a resident receiving levothyroxine for hypothyroidism. The resident had a documented diagnosis of hypothyroidism and an order for levothyroxine 50 mcg by mouth once daily every other day, revised on 05/06/24. Review of the electronic medical record from January 2025 through February 2026 showed no evidence that a thyroid-stimulating hormone (TSH) lab was ordered or completed to monitor the effectiveness of the thyroid hormone replacement therapy. The resident’s care plan indicated that the pharmacist would review medications monthly and as needed, and that staff were to monitor labs and diagnostic tests as ordered by the physician, but there was no corresponding TSH order in the physician’s orders. The resident’s Annual MDS documented a BIMS score of 15, indicating intact cognition, and showed that the resident required only setup or clean-up assistance with bathing and was independent with other activities of daily living. During observation, the resident was seen lying in bed on his left side with covers pulled up to his chest. In an interview, an administrative nurse stated she expected labs to be ordered for residents on levothyroxine. The facility’s Medication Monitoring Medication Regimen Review and Reporting policy stated that the goal of the medication regimen review was to promote positive outcomes and minimize adverse consequences and potential risks associated with medication, but the lack of TSH monitoring for this resident’s levothyroxine therapy demonstrated a failure to follow through with appropriate lab monitoring for an unnecessary drug review.
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