Failure to Provide Timely and Correct Radiology Services
Penalty
Summary
A deficiency occurred when the facility failed to provide or obtain timely and appropriate radiology services for a resident with severe cognitive impairment and multiple comorbidities, including type 2 diabetes and dementia. The resident was observed with swelling, bruising, and discoloration on the right wrist, which was possibly related to a prior fall. A nurse practitioner assessed the resident and ordered a stat x-ray of the right hand and wrist, along with ice pack application. The stat x-ray order was not fulfilled within the expected four-hour window, and the x-ray provider was unresponsive to follow-up calls from nursing staff. The x-ray was eventually performed more than 24 hours after the initial order, but it was conducted on the resident's right leg (tibia/fibula) instead of the wrist as ordered. The radiology report for the leg was negative for fracture, and the resident continued to experience swelling and bruising of the right hand. Despite ongoing monitoring and communication with the resident's responsible party, the correct imaging of the wrist was not obtained in a timely manner, and the resident's pain was managed with ice packs and Tylenol. Subsequently, the resident was sent to the emergency room for further evaluation due to persistent swelling and bruising of the right hand. Hospital imaging revealed a nondisplaced fracture of the distal radius (wrist), which had not been identified by the initial, incorrect x-ray. Interviews with facility staff and administration confirmed that the stat x-ray order was not properly processed, follow-up was inadequate, and communication breakdowns occurred. The facility did not provide a policy on x-ray services during the survey.