Failure to Timely Arrange Dermatology Referral for Resident with Skin Lesion
Penalty
Summary
The facility failed to follow a physician's order to arrange a dermatology appointment within a reasonable timeframe for a resident with an open lesion on the left cheek, which had been biopsied and identified as basal cell carcinoma. The physician's order for a dermatology referral was given and signed off by nursing staff, and both the resident and her family were notified of the referral. However, there was a two-month gap between the order and the actual dermatology appointment, with no documentation in the clinical record of attempts to make the appointment or any rationale for the delay. Staff interviews revealed that the initial dermatology referral was denied by insurance, and no appointment was scheduled as a result. The Assistant Director of Nursing was unaware of whether the dermatology office had contacted the resident or her family regarding the denial. Once it was discovered that no appointment had been made, a second referral was sent, but the clinical record did not specify when this occurred. Both the resident and her daughter confirmed they had not received any calls from the dermatology office. The facility's policy required consistent and effective order management, but this was not followed in this case.