Failure to Administer Ordered Permethrin Treatment and Notify Physician
Penalty
Summary
The deficiency involves the facility’s failure to follow a physician’s orders for Permethrin 5% cream treatment for a resident with a dermatological rash and a dermatology diagnosis of arthropod assault. Nursing progress notes documented that the resident had a rash on the right front axilla, and a physician’s order dated February 4, 2026, directed application of Permethrin 5% cream from neck to feet for one day, to be left on for eight hours, then showered off, and repeated in seven days. The February 2026 MAR showed that Permethrin was not administered on February 4 and February 12, 2026. Nursing notes on February 5, 2026, recorded that Permethrin was not administered without providing a reason, and on February 12, 2026, documented that the medication was awaiting delivery. There was no documentation that the physician was notified of these missed treatments. A dermatology consult dated March 4, 2025, documented a diagnosis of arthropod assault and an order to start Permethrin 5% cream, applied from neck down to feet for eight hours and then rinsed off. The MAR showed that Permethrin was not administered on March 5, 2026, and nursing notes on that date indicated the medication was waiting for delivery from the pharmacy. During an interview, the DON stated that Permethrin cream was not applied on the identified dates because the pharmacy did not deliver the medication and confirmed there was no follow-up by the facility to the pharmacy to obtain the medication. There was also no documentation that the physician was notified of the missed Permethrin treatments, resulting in a failure to ensure the ordered treatment was provided as prescribed.
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