Failure to Follow Physician Orders for Antibiotics, Wound Care, and Antihypertensives
Penalty
Summary
The deficiency involves multiple failures to provide treatment and care according to physician orders and residents’ needs. One cognitively intact resident on IV Daptomycin for a MRSA left hip wound had an infectious disease (ID) consultant visit, after which the ID physician ordered continuation of IV Daptomycin until a specified date. The resident reported taking a photo of the written order and giving it to the nurse upon return from the appointment. Despite this, the facility’s records show no administration of the antibiotic or documented reason for non‑administration over three consecutive days, and the Unit Manager later stated she was unaware of any issue and had no explanation for why the consultant’s order was not implemented. Another resident was admitted without documented left leg skin issues, but a weekly skin assessment later documented a skin tear to the left lower leg following a fall. Subsequent weekly skin checks did not mention the skin tear, and there were no physician orders for care of the left leg wound. Over several days of observation, the same large wound dressing, dated from the day of the fall, remained on the resident’s left leg, with curled edges and a visible bloody area beneath, indicating the dressing had not been changed. The Unit Manager, when shown the dressing, agreed with the findings. The facility also failed to follow and document parameters for antihypertensive medications for two residents with hypertension. One resident had an order for Metoprolol with instructions to hold the dose for systolic blood pressure less than 100 or heart rate less than 60, yet the MAR for the month lacked any blood pressure or heart rate readings associated with the medication doses. During a medication pass, the RN held a dose based on a low blood pressure reading, but the MAR reflected a different blood pressure not taken at that time, and routine vital sign documentation did not specify times or consistently capture readings at both ordered dosing times. For another resident with multiple chronic conditions, including chronic diastolic heart failure and hypertension, Metoprolol was ordered with parameters to hold for low systolic or diastolic blood pressure or low heart rate. Review of the MAR showed multiple instances where the medication was documented as given despite diastolic blood pressures below the ordered threshold, and both the DON and an LPN later acknowledged that the medication had been administered when it should have been held.
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