Delay in Post-Fall Evaluation and Failure to Update Care Plan for Cast and ADL Needs
Penalty
Summary
The deficiency involves a failure to provide timely treatment and care following an unwitnessed fall and to update the comprehensive care plan for cast management and ADL limitations. A resident returned from an out‑of‑facility pass with family and was observed in the dining room without complaints of pain that afternoon. Later that evening, a CNA reported the resident complained of left elbow pain with limited movement and slight swelling during evening care. The RN on duty assessed the resident, noted confusion and inconsistent accounts of a fall, and contacted the NP, who ordered an X‑ray of the left elbow along with laboratory tests. The X‑ray was not performed until the following evening, more than 24 hours after the reported onset of pain, and the RN who received the order did not follow up on the delay, stating that X‑ray services usually arrived after her shift. When the X‑ray was finally completed, it showed a fracture of the left elbow, and the NP ordered the resident sent to the hospital ER for further evaluation. The RN notified the family member and arranged ambulance transport but was informed there would be a two‑hour delay because it was considered non‑emergent. The RN did not notify the NP of this delay. The family member then chose to transport the resident to the hospital by private car around 10:00 PM. The DON later stated he was not aware that the family, rather than an ambulance, transported the resident. The NP stated it was expected that the resident should be transported immediately to the hospital for evaluation once the fracture was identified, given that the report of fall and pain had already been present for over 24 hours. The facility also failed to carry over hospital discharge instructions and revise the resident’s comprehensive care plan for cast management and ADL limitations after the fracture and subsequent ORIF surgery. Hospital discharge instructions after cast application included elevation of the arm, use of ice packs, keeping the cast dry, and pain management parameters, and post‑surgical instructions included limb elevation on a pillow, maintaining dressings, parameters for calling 911 or the MD, and scheduled ice application. These instructions were not transcribed into the active physician orders or incorporated into the comprehensive care plan. The restorative nurse stated she only updated the fall care plan and believed floor nurses were responsible for ADL and cast management updates, while the care plan coordinator stated the care plan should be updated with changes in condition or treatment. The resident’s comprehensive care plan and active orders did not reflect the cast management needs or ADL limitations related to the left arm cast, despite the resident having dementia, a history of fracture, and ongoing functional limitations.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.