Failure to Follow Physician Orders and Coordinate Specialized Services for Pain Management
Penalty
Summary
The facility failed to follow physician's orders and provide appropriate specialized services for a resident with intellectual disabilities and autism who was experiencing worsening left knee pain and limping. The resident had been evaluated by an orthopedic specialist, who ordered imaging with IV sedation due to the resident's diagnoses, as well as interventions such as rest, activity modification, ice and heat application, and topical pain relief. Despite these orders, the facility did not ensure the imaging was completed, did not implement the recommended interventions, and did not update the resident's care plan to reflect the ongoing pain and mobility issues. Multiple attempts to arrange the ordered imaging were unsuccessful, with documentation showing confusion and lack of follow-through regarding the need for IV sedation and the appropriate facility for imaging. The resident was taken to a local hospital that could not perform the imaging as ordered, and there was no evidence that alternative arrangements were made in a timely manner. Additionally, blood tests verbally ordered by the provider to rule out rheumatoid arthritis were not obtained until over a month later, and the care plan was not updated to address the resident's pain or mobility changes. Staff interviews revealed a lack of understanding of the need to continue coordinating care after a specialist referral, as well as failures to implement and document physician orders and care plan updates. The Director of Nursing Services confirmed that staff did not follow up appropriately with the primary provider or implement the specialist's recommendations, and that provider notes were not consistently reviewed or acted upon after appointments.