Delay in Ordering Orthotic Consultation and Device
Penalty
Summary
The facility failed to ensure that an orthotic consultation, as recommended by physical therapy, was ordered in a timely manner for a resident with significant mobility impairments. The resident, who had diagnoses including paraplegia, hemiplegia, and hemiparesis, was identified as being at risk for decline in activities of daily living and mobility. Physical therapy documented the need for an orthotist consult for a left ankle-foot orthosis (AFO) and communicated this need to the interdisciplinary team. However, there was no corresponding order for the orthotic device or referral for consultation found in the resident's medical record. Interviews revealed that the social services director was unaware of the recommendation and had not received communication from rehabilitation regarding the need for the brace. Further review indicated that the process for obtaining orthotic devices involved assessment and recommendation by the rehab department, followed by communication to social services and nursing to obtain an order and schedule an appointment with the vendor. Despite the physical therapist's and director of rehabilitation's efforts to communicate the need for an AFO, including emails to the social services assistant and the DON, no action was taken for nearly a month. The DON acknowledged that this delay was excessive and that there was no policy in place for orthotic consults. This lack of timely coordination and communication resulted in a delay in the resident receiving the necessary orthotic device.