NICHOLASVILLE, KY – NICHOLASVILLE NURSING & REHABILITATION

Based on interview, record review, review of the facility’s Job Description, and review of the facility’s policies, it was determined the facility failed to ensure the resident’s Advanced Practice Registered Nurse (APRN) #1 reviewed the resident’s total program of care, including medications and treatments at each visit for one (1) of four (4) sampled residents (Resident #1).

On [DATE] at approximately 2:30 PM, the facility admitted Resident #1 from an acute care facility with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . The hospital’s Infectious Disease (ID) Specialist ordered the resident to have the antibiotic [MEDICATION(S)], six hundred (600) milligrams (mg) every twelve (12) hours to treat the infection, and continue it through [DATE]. Based on documentation in the medical record, APRN #1 did not follow through with continuing the ID Specialist’s antibiotic ([MEDICATION(S)]) order. The APRN discontinued the [MEDICATION(S)] without documenting a clinical rationale or addressing the resident’s total program of care related to the UTI.

On [DATE], APRN #1 performed a telehealth visit with Resident #1. Review of the visit notes revealed APRN #1 acknowledged the resident’s UTI with MRSA. However, there was no documented evidence APRN #1 reviewed the resident’s current list of medications, as she only documented to see the Medication Administration Record [MEDICAL RECORD OR PHYSICIAN ORDER] . APRN #1 failed to include [MEDICATION(S)] in the current plan as related to the UTI.

On [DATE], Resident #1’s daughter inquired about Resident #1 receiving the ordered antibiotic for the UTI and was informed Resident #1 was not receiving the medication. The facility contacted the Medical Director (MD) who ordered an in-and-out catheterization to obtain the specimen and re-ordered [MEDICATION(S)], along with two (2) other antibiotics. However, by then, Resident #1 had missed eleven (11) doses of [MEDICATION(S)]. On [DATE], Resident #1 exhibited vomiting, complaints of shortness of air, and chilling; Resident #1 was sent to the hospital. Review of Resident #1’s Hospital Discharge Summary, revealed

Resident #1 expired, on [DATE], and the cause of death was listed as UTI, Ischemic [CONDITION(S)], Lactic Acidosis, and Acute Kidney Injury.

The facility’s failure to ensure Resident #1’s Physician/APRN reviewed the resident’s total program of care, including medications and treatments, has caused or is likely to cause serious injury, harm, impairment, or death to a resident. Immediate Jeopardy was identified on [DATE], and was determined to exist on [DATE], at 42 CFR 483.30 (b) Physicians Visits (F711). The facility was notified of the Immediate Jeopardy on [DATE].

The facility submitted an acceptable Allegation of Compliance (AoC) on [DATE], alleging removal of the Immediate Jeopardy, and to be in substantial compliance, on [DATE]. The State Survey Agency validated the AoC, on [DATE], and determined the facility implemented corrective actions and was in compliance on [DATE], as alleged, prior to the State Survey Agency’s investigation. Therefore, it was determined to be Past Immediate Jeopardy.