Failure to Care Plan for Resident’s Refusal of Hyperkalemia Medication
Penalty
Summary
Surveyors identified a deficiency in the facility’s development and implementation of a person-centered comprehensive care plan related to a resident’s refusal of ordered medication. The resident was admitted with diagnoses including end stage renal disease, COPD, and essential hypertension. An MDS assessment documented that the resident’s cognitive skills for daily decision-making were intact, and a subsequent H&P stated the resident had the capacity to understand and make decisions. A physician’s order directed administration of Lokelma 10 grams orally on specific days for treatment of hyperkalemia. The MAR for the relevant month showed that on 2/1/2026 the resident refused the ordered Lokelma dose. During concurrent record review and interview, the ADON confirmed there was no care plan addressing the resident’s refusal of Lokelma and acknowledged that the nurse should have notified the physician and documented the refusal. The ADON stated that without a care plan for the refusal, there would be no intervention to correct the resident’s hyperkalemia and this could potentially cause further increase in potassium levels. In a separate interview, the DON stated that a care plan should have been developed for the resident’s medication refusal to create a new treatment plan to prevent further elevation of potassium, and that without such a care plan the resident’s hyperkalemia might not be corrected. The facility’s comprehensive care plan policy indicated that a CCP is to be developed for each resident to ensure individualized, resident-centered care addressing medical needs and updated based on resident conditions and preferences, which was not followed in this case.
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