Failure to Immediately Notify NP/MD of New Osteomyelitis Diagnosis After Outside Appointment
Penalty
Summary
The deficiency involves the facility’s failure to immediately notify and consult with a resident’s physician or NP/MD when there was a significant change in the resident’s condition and diagnosis. The resident was an older male with diabetes mellitus with hyperglycemia and a history of open wounds on the left foot and great toe. He had been referred to a podiatrist and then to a local hospital due to concern for osteomyelitis in the left foot, with MRI imaging consistent with left calcaneal osteomyelitis and possible left 5th toe osteomyelitis. Despite this new diagnosis, the facility’s records did not show that the NP/MD was promptly informed of the osteomyelitis. Record review showed a podiatrist progress note indicating erosion of the left 5th toe consistent with osteomyelitis and a plan to consult infectious disease, but there was no corresponding nursing progress note documenting notification to the NP/MD of this new diagnosis. A progress note dated two days later documented that the resident was sent to the hospital for further evaluation regarding osteomyelitis, but the facility’s documentation did not reflect that the NP/MD had been notified when the diagnosis was first identified. The resident’s care plan included IV therapy related to osteomyelitis, with interventions such as administering IV fluids per order, monitoring for infection, and notifying the physician of signs and symptoms of infection or complications, but the initial diagnostic information from the podiatrist visit was not promptly relayed. In interviews, nursing staff and leadership described that the receiving nurse was responsible for reviewing outside provider notes and immediately notifying the NP/MD of any new orders or diagnoses, and then documenting a progress note. LVN staff acknowledged that failure to notify the NP/MD could cause a delay in care and miscommunication, and one LVN stated he only learned of the osteomyelitis diagnosis from the resident’s POA. The NP reported she was not notified by facility nurses about the osteomyelitis diagnosis and instead learned of it from a family member. The DON stated that because the podiatrist’s note contained no new orders and described the condition as stable with a referral to infectious disease, she believed immediate notification of the NP was not necessary and that next-day notification would be acceptable. The facility’s written policy on change in resident condition required licensed nurses to notify the attending physician or designee and resident representative in situations requiring a change in medication or treatment regimen, including new conditions and skin issues, but the osteomyelitis diagnosis was not immediately communicated to the NP/MD as required.
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