Chapel Manor Philadelphia (August 6th)

Based on staff interview and clinical record review, it was determined that the nursing home failed to obtain, clarify, or complete physician’s orders related to treatments, medications and laboratory studies, for three of 30 residents reviewed. The findings included the following: A review of the initial nursing assessment, revealed that the resident had been identified with a wound on the left lateral ankle that measured 2.0cm x 1.0cm, and wound on the left lateral calf that measured 2.0cm x 2.0cm. Review of physician’s orders dated July 16, 2013 revealed that the physician ordered Santyl to the ankle wound and cover with a dry dressing. Nursing documentation dated July 16, 2013 indicated the staff of the facility was also applying Santyl to the calf wound. In an interview with the Director of Nursing on August 6, 2013 at 11:30 a.m. confirmed that the staff had been applying a treatment of an undisclosed medicine. Review of Resident R55’s clinical record revealed a history of chronic urinary catheter usage related to urinary incontinence and a sacral pressure ulcer. Physician’s orders, dated May 2, 2013, indicated a Urology consult be completed due to the resident’s urinary catheter leaking. A physician’s order, dated May 6, 2013, changed the size of Resident R55 urinary catheter to a larger size diameter, from a Fr 16 to a Fr 20, due to continued leakage. Review of the Urology consult, completed May 16, 2013, found the resident’s urine leakage was now deceased with the current catheter. The consultant urologist recommended that the resident return in six months, and if urine leakage were to continue, start a medication used to treat symptoms of overactive bladder such as leakage, three times a day.

Review of Resident R55’s physician’s orders, dated May 17, 2013, found the nurse wrote if leakage continues start 5 mgm (milligrams) three times daily. Review of Resident R55’s MARs revealed that the medication was administered starting on May 18, 2013 and continues August 2013. There was no documentation available for review to show that Resident R55 had any urinary leakage or indication for medication usage after May 16, 2013, urology consult. There was no documentation available for review to show that Resident R55 had any urinary leakage or indication, for medication usage after the May 16, 2013, urology consult. There was no indication that the physician was contacted to clarify the medication order form or to obtain a standing order for daily medication. These findings were confirmed in an interview with licensed nurse on Employee E1 on August 6, 2013, at 11:30 a.m. nursing documentation indicated that the resident had been readmitted to the nursing home following a hospital stay. A review of laboratory study results revealed that chemistry blood tests had been performed eight separate times on June 13, June 20, June 27, July 5, July 11, July 18, July 25 and August 1, 2013. A review of physician’s orders did not reveal an order from the physician to perform any of these studies. An interview with Employee E3 confirmed that the facility performed laboratory studies without a physician’s order.