Failure to Obtain Ophthalmology Evaluation for Resident With Vision Impairment
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a resident with reported visual impairment received appropriate treatment and access to ophthalmology services to maintain vision abilities. During an interview, Resident #64 reported visual impairment, a need to see an ophthalmologist, and that this request had not been fulfilled, stating that the glasses at bedside did not work and that special glasses were needed. The admission MDS assessment documented the resident’s vision as adequate with glasses, and an earlier PCP note recorded vision as within normal limits, but a subsequent nutrition note indicated the resident required setup/clean-up assistance related to vision loss. A later PCP note specifically directed that ophthalmology follow-up appointments should be scheduled as necessary, with regular monitoring and evaluation by an ophthalmologist. Progress notes also documented the resident’s complaint of dry eyes and an order for artificial tears. Staff interviews and record review showed that the facility was aware of the resident’s vision issues but did not complete the process to obtain an ophthalmology visit. The unit manager described the standard process for arranging ophthalmology appointments but was initially unsure whether there was an in-house ophthalmologist and later stated that appointments depended on insurance qualification, with others referred out. A GNA reported the resident was partially blind and required assistance with care. An LPN acknowledged that the resident had glasses at the bedside that were reported as not working, though the LPN stated the resident had not specifically reported current vision issues to her. The NP reported that the resident had expressed difficulty seeing and requested eye wash, and that she could not prescribe eye wash without an ophthalmologist assessment; she stated she had been attempting to schedule an appointment but was unsure about insurance coverage. The DON reported the resident was being reviewed for an ophthalmologist assessment but was unsure of the conclusion. There was no documented evidence that the facility had appropriately assessed and/or treated the resident’s vision impairment issues or secured an ophthalmology evaluation, despite multiple indications of visual problems and provider recommendations for ophthalmology follow-up.
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