Lack of Care Planning and Coordination for Brain Mapping/Neurofeedback Therapy
Penalty
Summary
The facility failed to provide treatment and care according to physician orders and residents’ needs for two residents who received brain mapping/neurofeedback therapy. One resident with Parkinson’s disease and severe cognitive impairment and another resident with unspecified dementia, aphasia, and severe cognitive impairment were referred by the MD for brain mapping/neurofeedback due to altered mental status. The MD acknowledged that this therapy was not a standard treatment for Parkinson’s disease or dementia but believed it might be beneficial, and later discontinued it after several weeks when no improvement was observed. Physician orders for both residents specified QEEG brain mapping initially and after every fifth neurofeedback session, with neurofeedback therapy 2–3 times per week for 20–40 sessions and re-evaluation for continuance based on therapeutic appropriateness and patient response. Treatment records showed that one resident received therapy from March through October and the other from March through May. The brain mapping/neurofeedback services were provided in the facility by a third-party provider. During surveyor interviews and record reviews, the Administrator confirmed that there were no nursing care plans addressing brain mapping/neurofeedback for either resident. The DSD/LVN reported that the provider did not give after-treatment care instructions for these therapies and that visit notes were not provided immediately, with uncertainty about when they were received by the facility. Despite the provider’s visit notes indicating that the plan of care was coordinated with the primary care team and nursing staff, and that counseling was provided to staff regarding adequate hydration and nutrition in conjunction with neurofeedback, the facility lacked corresponding nursing care plans and documented after-treatment care. The Administrator also reported that one resident’s responsible party requested discontinuation of the therapy due to lack of improvement and stated they had not given consent for the treatment.
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