Failure to Follow Medication Parameters and Accurately Enter Hospice and Weight-Bearing Orders
Penalty
Summary
The deficiency involves multiple failures to provide treatment and care according to physician orders and residents’ needs. One resident with diagnoses including hypokalemia, dementia, and essential hypertension had a physician’s order for losartan 50 mg daily, later increased to 75 mg daily, with instructions to hold the medication if the systolic blood pressure (SBP) was less than 110. Review of the MARs and blood pressure logs for December and January showed that staff did not document checking this resident’s blood pressure on numerous mornings before administering losartan, and the DON confirmed that the blood pressure was not checked every morning during that period. As a result, it was unclear whether the ordered parameters to hold the medication for low SBP were followed. The deficiency also includes failures related to hospice admission orders and therapy orders for two residents. One resident was readmitted with an order to admit to SNF and had active orders for PT, OT, and SLP. A hospice nurse visit note documented that hospice services started on a specific date, but the hospice admission order was not entered into the medical record until a week later, leaving the SNF and therapy orders active. Another resident was admitted and later discharged, with documentation showing a hospice admission agreement signed by family and a hospice nurse visit note indicating the start of hospice services on a certain date. However, the hospice admission order was not entered into the medical record until several days later, and the PT order remained active and was not discontinued until days after hospice services began. The therapists and the DON confirmed that residents on hospice should not be receiving PT, OT, or SLP and that hospice and SNF/therapy orders were not updated timely in the medical record. Additionally, the facility failed to correctly enter weight-bearing orders for another resident at admission. Convalescent care orders specified weight bearing as tolerated for the right leg and partial weight bearing for the left leg. When these orders were entered into the medical record, staff documented only “weight bearing as tolerated” without specifying the right leg and did not enter any order for partial weight bearing on the left leg. An LPN and the DON confirmed that the convalescent care orders included both right-leg weight bearing as tolerated and left-leg partial weight bearing, that these were not fully or correctly entered into the medical record, and that staff were expected to review and enter all such orders correctly at the time of admission.
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