Failure to Follow Up on Ordered MRI/CT Imaging After Cancelled Appointment
Penalty
Summary
The deficiency involves the facility’s failure to implement a resident’s care plan intervention to obtain and monitor ordered diagnostic work, specifically MRI and CT imaging, and to follow up as indicated. The resident had multiple significant diagnoses, including hemiplegia and hemiparesis following a cerebral infarction, morbid obesity, and lumbar radiculopathy, and was chairbound, used a manual wheelchair, and required substantial assistance with several activities of daily living. The resident’s care plan included a nursing intervention directing staff to obtain and monitor lab/diagnostic work as ordered by the physician, report results to the physician, and follow up as indicated. The physician ordered MRI of the thoracic and lumbar spine and a CT of the thoracic spine, with the tests scheduled at an outside testing center. Nursing documentation showed that on the scheduled date, the resident was transported by ambulance to the appointment and later returned without having the MRI and CT completed because the resident’s weight prevented use of the imaging equipment. Nursing progress notes documented that the resident could not undergo the procedures due to being overweight and that a new place was needed, but there were no subsequent notes describing any follow-up by the facility to arrange completion of the ordered tests. RN 2 recalled that the resident returned without the tests being done because of size limitations of the equipment and stated that a new diagnostic testing location was needed and that the matter was endorsed to the case manager. However, RN 2 acknowledged that after the progress notes from that date, there were no further notes describing follow-up by nursing to reschedule the MRI and CT, and confirmed that the tests had not been rescheduled. RN 1, upon review of the record, also could not locate any documentation of follow-up after the cancelled appointment and stated that the care plan intervention to follow up on diagnostic work as ordered was not implemented. The DON stated that there had been a delay in care when the MRI and CT appointments were cancelled and the facility did not follow up as indicated in the resident’s care plan. The Director of Admissions, who had assisted with case management, explained that the process for diagnostic imaging involved obtaining the physician’s order, securing insurance approval when required, and then scheduling at an appropriate testing center, often with assistance from corporate case managers. The Appointment Information sheet showed that the MRI and CT appointment had been scheduled, but the Director of Admissions reported not being informed that the appointment was cancelled and therefore did not initiate efforts to find another imaging center that could accommodate the resident’s size. Facility policies on comprehensive person-centered care planning required that care plans include physician orders and interventions addressing resident needs, and the RN job description required RNs to implement nursing interventions in the plan of care and complete medical treatments as ordered. Despite these requirements, the ordered diagnostic imaging and the care plan intervention to follow up on diagnostic work were not carried out after the initial failed appointment, resulting in delayed treatment for the resident.
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