Delay in Initiation of Ordered Therapy Services
Penalty
Summary
A deficiency occurred when a resident with a history of hemiplegia, hemiparesis following a stroke, anxiety, chronic heart failure, COPD, and diabetes was not provided with timely physical therapy (PT) and occupational therapy (OT) services as ordered. The resident, who had severe cognitive impairment and an activated healthcare power of attorney, was admitted with significant functional needs and had previously been discharged from OT and PT after reaching a plateau. On 4/29/25, new physician orders were written to initiate PT and OT, but these services were not started until 7/14/25. During this period, there were no progress notes or documentation in the electronic health record (EHR) indicating that therapy services had been initiated or evaluated as per the new orders. Staff interviews revealed that the therapy department typically relies on notification from the in-house nurse practitioner for new therapy orders, but in this case, the resident's physician was external. The Director of Rehab (DOR) acknowledged responsibility for the delay, stating that the therapy order was overlooked until the Nursing Home Administrator (NHA) brought it to their attention after the resident's power of attorney requested therapy. The nurse supervisor confirmed that new orders should be transcribed into the EHR, but was unable to locate the therapy orders in the appropriate section. The facility did not have a policy or procedure for following physician orders or for initiating rehabilitation services when ordered, contributing to the delay in providing required therapy services.