Failure to Timely Clarify and Implement Orthopedic Brace and Wrist Care Orders
Penalty
Summary
Failure to provide appropriate treatment and care according to orders, resident preferences, and goals occurred when the facility did not obtain or clarify new orthopedic recommendations following a resident’s follow‑up appointment and did not timely update the medical record. The resident had a history of fractures of the left hand, distal radius and ulna of the left wrist, and superior and inferior pubic ramus fractures of the left pelvis, with prior instructions to use a left wrist splint and a platform walker to avoid weight bearing through the left wrist. During a morning medication pass, an RN observed that the resident’s left arm cast had been removed after an orthopedic follow‑up visit and noted that the left wrist remained slightly swollen. The resident and her husband reported that a brace had been provided and that they were told it could be worn whenever the resident wanted, but at that time the resident was not wearing the brace and there was no documentation in the electronic medical record regarding new orthopedic instructions or the brace. The after‑visit summary for the follow‑up appointment documented only an occupational therapy referral and did not mention a brace or revised instructions for wrist support or weight bearing. The ADON initially stated he was unaware of any brace sent with the resident after the appointment, and by the end of that day there were still no nursing notes in the EMR describing the orthopedic follow‑up findings or any new recommendations. A late entry progress note later documented that the splint had been removed and an OT referral given, but the original lack of timely documentation and clarification meant that the resident’s care orders, including use of a Velcro wrist brace and clarification of weight‑bearing status, were not updated in the EMR until two days after the follow‑up visit.
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