Failure to Follow Physician Orders for Laboratory Testing for Two Residents
Penalty
Summary
The deficiency involves the facility’s failure to ensure that residents received treatment and care in accordance with professional standards of practice by not following physician orders for laboratory testing. For one resident with a history of acute pulmonary edema and intact cognition, the physician ordered a Brain Natriuretic Peptide (BNP) test to be obtained every second Monday in February and August. The February Medication Administration Record showed the BNP was scheduled but not signed off as completed on the specified date, and further record review did not show evidence that the BNP was obtained as ordered. During an interview, the resident reported being given a fluid pill for leg swelling that had not helped, and the Assistant Director of Nursing Services acknowledged that the ordered BNP test was not completed. For a second resident admitted with hypertension, the physician documented a new order in a progress note for a repeat Basic Metabolic Panel (BMP) to be obtained in one week. Record review failed to show that this repeat BMP was completed within the ordered timeframe. In an interview, the Assistant Director of Nursing Services was unable to provide evidence that the repeat BMP had been obtained as ordered. These missed laboratory tests, despite clear physician orders, constitute the failure to provide care and services in accordance with professional standards of quality.
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