§483.25(a) Vision and hearing
To ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities, the facility must, if necessary, assist the resident-
§483.25(a)(1) In making appointments, and
§483.25(a)(2) By arranging for transportation to and from the office of a practitioner specializing in the treatment of vision or hearing impairment or the office of a professional specializing in the provision of vision or hearing assistive devices.
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Observations:
Based on clinical record reviews and staff interviews, it was determined that the facility failed to follow recommendations from the optometrist for follow-up appointments for five of seven residents (Residents 2, 3, 4, 6, 7).
Findings include:
An optometrist (a healthcare provider who specializes in caring for your eyes) note for Resident 2, dated March 27, 2023, revealed that the resident presented for a diabetic eye exam, and the patient was receiving care pursuant to an order from the primary care physician. Upon the primary care physician's review of the most current consult note and plan of care, should the primary care physician not agree with the medical necessity of both the care and plan of care, the optometrist was to be notified immediately, and that the resident was to return in six to nine months for a dilated fundus exam (a diagnostic procedure that uses eye drops to dilate or enlarge the pupil in order to obtain a better view of the fundus, the inside, back surface of the eye).
There was no documented evidence that the optometrist's recommendation for Resident 2 to return in six to nine months was completed or that the resident's physician disagreed with the optometrist's plan of care.
An optometrist note for Resident 3, dated March 27, 2023, revealed that the resident was seen for a diabetic exam in the right and left eye, and upon the primary care physician's review of the most current consult note and plan of care, should the primary care physician not agree with the medical necessity of both the care and plan of care, the optometrist was to be notified immediately. Resident 3 was to return in six to nine months for a dilated fundus exam.
There was no documented evidence that the optometrist's recommendation for Resident 3 to return in six to nine months was completed or that the resident's physician disagreed with the optometrist's plan of care.
An optometrist note for Resident 4, dated March 27, 2023, revealed that the resident presented for an evaluation of blurry vision in the right and left eyes, and that the patient was receiving care pursuant to an order from the primary care physician. Upon the primary care physician's review of the most current consult note and plan of care, should the primary care physician not agree with the medical necessity of both the care and plan of care, the optometrist is to be notified immediately, and that the resident was to return in six to nine months for a dilated fundus exam.
There was no documented evidence that the optometrist's recommendation for Resident 4 to return in six to nine months was completed or that the resident's physician disagreed with the optometrist's plan of care.
An optometrist note for Resident 6, dated March 27, 2023, revealed that the resident was seen for a diabetic exam in the right and left eye, and upon the primary care physician's review of the most current consult note and plan of care, should the primary care physician not agree with the medical necessity of both the care and plan of care, the optometrist was to be notified immediately. Resident 6 was to return in six to nine months for a dilated fundus exam.
There was no documented evidence that the optometrist's recommendation for Resident 6 to return in six to nine months was completed or that the resident's physician disagreed with the optometrist's plan of care.
An optometrist note for Resident 7, dated March 27, 2023, revealed that the resident presented for an evaluation of Glaucoma (a group of eye diseases that can cause vision loss and blindness by damaging a nerve in the back of your eye called the optic nerve), and that the patient was receiving care pursuant to an order from the primary care physician. Upon the primary care physician's review of the most current consult note and plan of care, should the primary care physician not agree with the medical necessity of both the care and plan of care, the optometrist is to be notified immediately, and that the resident was to return in three to six months for intraocular pressure (IOP - the fluid pressure of the eye), gonioscopy (a test performed by an eye doctor to evaluate the internal drainage system of the eye), and pachymetry (a test that measures the thickness of the cornea, the clear membrane located at the front of the eye).
There was no documented evidence that the optometrist's recommendation for Resident 7 to return in three to six months was completed or that the resident's physician disagreed with the optometrist's plan of care.
Interview with the Nursing Home Administrator on March 4, 2024, at 11:20 a.m. confirmed that there was no documented evidence that Residents 2, 3, 4, 6, and 7 had follow up appointments completed as recommended by the optometrist.
28 Pa. Code 211.12(d)(3)(5) Nursing Services.
| | Plan of Correction - To be completed: 04/01/2024
The contracted optometry service through 360 care who failed to follow up per their plan of care is no longer coming to the facility for these individuals. A local optometrist from the community Dr. Nathan Stebbins will visit 3/21/24 to examine these individuals and provide care and services as needed going forward.
Any additional residents in the facility who would like to see the optometrist will be scheduled based on resident request, family request, or as needed for changes in eye condition.
The Assistant Director of Nursing or designee will review optometry reports upon receipt and schedule follow up as needed per plan of care.
Audits of residents seen and follow up visits scheduled will be provided to the Quality Assurance Committee monthly for review x 3 months.
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