Failure to Timely Schedule and Obtain MRI for Resident with Ongoing Hip Pain
Penalty
Summary
The facility failed to ensure timely scheduling and completion of a magnetic resonance imaging (MRI) for a resident with a history of a displaced fracture of the right acetabulum and surgical site infection. The MRI was ordered by a nurse practitioner due to the resident's ongoing right lower extremity weakness and pain, but the order was not processed or scheduled in a timely manner. The resident reported increased pain and functional decline, including difficulty lifting his right leg and increased pain after physical therapy, which prompted the MRI order. Despite the physician's order for the MRI being placed, the facility did not complete the necessary referral form or schedule the appointment until nearly a month later. The scheduling coordinator did not receive the transportation request form from nursing until the following month, and the MRI order was marked as complete and discontinued in the electronic medical record without the procedure being performed. Staff interviews revealed confusion and breakdowns in communication and order processing, with the scheduling coordinator unaware of the outstanding order and the MDS coordinator deleting old orders from the system under the assumption they had been completed. The resident did not receive the MRI as recommended by the nurse practitioner, and there was no documentation in the medical record that the MRI had been performed during the period in question. The delay was attributed to lapses in the facility's internal processes for handling diagnostic orders, including missed communication between nursing, the scheduling coordinator, and the use of the electronic charting system.