§ 483.25 Quality of care
Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices.
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Observations:
Based on clinical record review and staff interview, it was determined that the facility failed to ensure that physician's orders were implemented for two of four sampled residents. (Residents 1, 2)
Findings include:
Clinical record review revealed that Resident 1 had diagnoses that included intervertebral disc displacement (when a disc in the spinal column shifts and presses on against the spinal nerves) and morbid obesity. A physician's order dated July 2, 2024, directed staff to cleanse surgical incision to lower back with normal saline solution and pat dry, to keep incision clean and dry, to keep the incision open to air and to apply folded abdominal pad dressing (ABD) on each side of the incision due to skin fold two times a day. A review of the July 2024 Treatment Administration Records (TAR) revealed that there was no evidence the treatment was done as ordered on July 3, 4, and 6, 2024.
Clinical record review revealed that Resident 2 had diagnoses that included metabolic encephalopathy and cellulitis of bilateral lower extremities. A review of physician's orders dated August 1 through 10, 2024, the Medication Administration Record (MAR) for August 2024, and Treatment Administration Record (TAR) for August 2024, revealed the following:
Staff were to apply ammonium lactate external lotion 12% to bilateral lower extremities daily for venous stasis. There was no evidence that the lotion was applied as ordered on August 5, 2024.
Staff were to administer doxycycline monohydrate (an antibiotic) oral capsule 100 milligrams (mg) two times a day. There was no evidence that the medication was administered as ordered on August 8, 2024.
Staff were to administer suboxone sublingual film (a narcotic) 2-0.5mg 1 film four times a day for narcotic dependence. There was no evidence that the medication was administered as ordered on August 5, 2024.
A physician's order dated July 2, 2024, directed staff to apply moisturizing lotion to the entire left lower leg then cover with ACE bandage from bottom of foot and work up to below the knee every day shift to maintain skin integrity. A review of the August 2024 TAR revealed there was no evidence the treatment was done as ordered on August 4 through 8, 2024.
In an interview on August 10, 2024, at 2:05 p.m., the Manager on Duty confirmed that there was no documented evidence that Residents 1 and 2 received the treatments and/or medications as ordered by the physician.
28 Pa. Code 211.12(d)(1)(5) Nursing services.
| | Plan of Correction - To be completed: 09/15/2024
1. Resident's #1 and #2 were assessed by the nurse to ensure there were no unfavorable outcomes related to missing medications or treatments. The physician of each resident was notified, and no new orders were given.
2. An audit was conducted of current residents for the last 30 days to ensure that medications and treatments were administered per physician orders. Any deficiencies identified were corrected immediately.
3. Licensed Nurses will be educated by the DON/Designee on the components of this regulation with an emphasis on ensuring that medications and treatments are administered per physician orders and documented appropriately in the medical record.
4. The DON/Designee will audit 5 random residents to ensure that medications and treatments are being completed and documented in the medical record 2x a week x2 weeks, 1x a week x4 weeks, then bi-monthly x2 months.
The findings of these quality monitoring's to be reported to the Quality Assurance/Performance Improvement Committee until monthly and/or until substantial compliance is met. Quality Monitoring schedule modified based on findings.
5. Date of compliance 9/15/24.
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