Failure to Arrange Ordered Orthopedic Consultation
Penalty
Summary
A deficiency occurred when the facility failed to arrange an orthopedic consultation as ordered for a resident who was admitted with multiple diagnoses, including congestive heart failure, hypertension, atherosclerotic heart disease, atrial fibrillation, venous insufficiency, diabetes, spinal stenosis, hypothyroidism, and anemia. The resident was transferred from assisted living to the skilled nursing facility due to increased difficulty with ambulation, and a new order was received for an orthopedic referral and pain management with Tramadol. Documentation in the medical record and occupational therapy evaluation indicated the resident was experiencing significant right knee pain and was awaiting an orthopedic appointment. Despite the physician's order for an orthopedic referral due to worsening knee pain, there was no evidence in the medical record that the referral was set up during the resident's stay. The resident, who had moderately impaired cognition, continued to report pain and was awaiting further assessment. The facility administrator confirmed that the orthopedic appointment was never scheduled, citing the short duration of the resident's stay as the reason.