Failure to Schedule Orthopedic Appointment Following Physician Orders
Penalty
Summary
The facility failed to follow up and schedule an orthopedic appointment for a resident who was admitted with diagnoses including a disorder of bone, primary osteoarthritis of the right knee, and generalized muscle weakness. The resident's history and physical indicated possible lytic erosive bone changes in the femur, with a recommendation for an orthopedic referral. Physician orders were documented on two occasions to arrange for an orthopedic appointment, specifically for a lytic lesion in the left femur. Despite these orders, there was no evidence that the appointment was scheduled or that appropriate follow-up occurred. Interviews with nursing staff and the Director of Nursing revealed that the responsibility for scheduling the appointment and documenting follow-up was not fulfilled. The facility's policy required coordination between social services and nursing for such referrals, but this process was not completed as expected. The lack of action resulted in a delay of care and treatment for the resident, as the necessary orthopedic evaluation was not arranged in a timely manner.