Failure to Ensure Physician Response to Pharmacist Medication Review Recommendations
Penalty
Summary
The facility failed to ensure that physicians acknowledged and addressed consultant pharmacist medication regimen recommendations for two residents, as required by policy and regulation. For Resident 6, clinical record review showed that the consultant pharmacist made recommendations regarding the medication regimen on March 20, 2026, but there was no documented evidence of the specific recommendation or that the attending physician had acknowledged or acted upon it. For Resident 12, clinical record review showed that the consultant pharmacist made recommendations regarding the medication regimen on October 20, 2025, and again on February 26, 2026, with no documented evidence of the recommendations or any physician acknowledgment or follow-up action. In an interview on April 17, 2026, at 10:22 a.m., the Director of Nursing confirmed that there was no documented evidence that the medication review recommendations made by the consultant pharmacist for Residents 6 and 12 were addressed by the physician, resulting in noncompliance with state management and nursing services regulations.
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