Failure to Follow Up on Physician-Ordered Urology Consultation
Penalty
Summary
The facility failed to provide necessary care and services for one resident by not following up on a physician-ordered urology consultation. The resident, who had a suprapubic urinary catheter, had a physician's order for a urology consult to address the catheter change. Documentation showed that the Case Manager initially contacted an outside facility to confirm eligibility for the consultation and was instructed to call back if no response was received by a specified time. However, there was no evidence that the Case Manager followed up as directed. Interviews with facility staff, including the LVN, Social Services Designee (SSD), and Case Manager, confirmed that the process for arranging outside consultations involves communication between licensed nurses, the SSD, and the Case Manager. All parties verified that the follow-up call to schedule the urology consult was not made, as required by the physician's order and facility policy. This lapse resulted in the resident not receiving the ordered consultation in a timely manner.