Delay in Reporting and Treatment of Post-Fall Hip Fracture
Penalty
Summary
The facility failed to timely report and address post-fall pain and did not implement radiology orders promptly for a resident who experienced a fall. After the resident was found on the floor in the early morning hours, initial assessments documented bruising and abrasions but no pain, and the on-call physician was notified. However, later therapy notes indicated the resident began complaining of significant left hip pain, refused to participate in therapy, and requested an x-ray. Despite these complaints, there was a delay in notifying the physician about the pain and in obtaining the necessary diagnostic imaging. Therapy staff reported the resident's pain to nursing staff, but there was no immediate follow-up with the physician regarding the new onset of pain. An x-ray was eventually ordered as STAT, but the imaging was not performed until the following day. The nurse practitioner was not notified of the resident's pain until the day after the x-ray order was placed, at which point a STAT x-ray was again ordered and the resident was placed on nonweight bearing status. The x-ray ultimately revealed an acute nondisplaced left femoral intertrochanteric fracture, requiring surgical intervention. Interviews with staff confirmed that the resident's complaints of pain were communicated between therapy and nursing, but not escalated to the provider in a timely manner. The delay in reporting and acting on the resident's post-fall pain, as well as the delay in obtaining the ordered x-ray, resulted in a delay in diagnosis and treatment of the hip fracture. Documentation also showed that the provider was not aware of the fall or the pain until well after the incident, and the facility's protocol for acute condition changes was not followed.