Failure to Notify Emergency Contact After Resident Injury and ER Transfer
Penalty
Summary
The facility failed to notify a resident's emergency contact after the resident sustained an injury and was transferred to the emergency room. According to the resident's face sheet, a specific individual was listed as the emergency contact. The resident, who was alert and had a history of previous injuries and hardware in her left leg, experienced swelling and bruising on her left lower extremity after her feet gave out during a transfer. Physical therapy staff informed the RN, and a nurse practitioner assessed the resident, resulting in an order to send her to the ER for imaging. The resident was transported to the ER via EMS. Despite the facility's policy requiring notification of the resident's representative in the event of significant changes such as swelling, skin discoloration, or transfer from the facility, the emergency contact was not informed by facility staff. Instead, the resident herself called her emergency contact from the emergency room to report the injury and transfer. The emergency contact expressed upset at not being notified by the facility, stating she would have provided family support at the ER if she had been informed.