Failure to Notify Provider of Delayed STAT X-ray Results
Penalty
Summary
A deficiency occurred when the facility failed to notify the on-call provider regarding delayed STAT x-ray results for a resident who was experiencing increased pain and decreased movement in the left arm. A STAT elbow x-ray was ordered and completed, but the results were not received for approximately 48 hours. During this period, a registered nurse contacted the mobile x-ray company and learned of the delay but did not inform the on-call provider about the missing results. The lack of timely notification to the provider persisted until the resident's power of attorney became upset and requested that the resident be sent to the emergency room, at which point the provider was finally notified and an order was obtained to send the resident out for further evaluation. The clinical record review and staff interview confirmed that there was no evidence of provider notification about the delay in receiving the STAT x-ray results, which was required by facility policy and regulations.