Wedgewood Healthcare Center was cited when the facility “failed to ensure a physician’s order for a left hip x-ray due to pain was completed in a timely manner.” This resulted in a delay of treatment for a resident.
The resident in this citation complained of pain in her left hip while in the common area of the memory unit. Staff reported that the pain was a new symptom, and so an x-ray was ordered. The goal of the x-ray was to check for a fracture to the hip, femur, and pelvis. However, the facility did not follow through with the x-ray.
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The investigator of this citation interviewed the facility’s Medical Director to find out where the breakdown in communication occurred among staff members. He stated his nurse practitioner was the person who ordered the x-ray, and it “should have been done.” This citation did not indicate why the facility did not ensure these orders were acted upon. The facility administrator told the investigator that “if an x-ray was ordered then I expect the x-ray to have been done.”
The resident’s Physical Therapy Assistant (PTA) stated that from a physical therapy standpoint, the resident’s progress was “up and down” because of her dementia. The PTA gave the following details regarding the resident’s physical condition:
- The whole time she was on service with us, she had tightness in her left hamstring, and we were doing ultrasounds to decrease the tightness. We were doing some standing on the parallel bars with weight shifting to promote weight bearing on the left leg. The hamstring was tight enough that her foot wouldn’t touch the ground so that’s why we were working with her, to loosen the hamstring. For someone who had dementia, she was clearer than you would think. She could tell you a few things.
- Throughout treatment she wasn’t complaining of much pain. For example, we would try and stand her up and she would complain of pain in her leg. I would ask her if she was okay, and she would say yes, I am fine. Then on [date redacted] she was in bed because she was on IV’s and I went to roll her and she was in a lot of pain. I was like ”ooo” and I talked to the nurse. Her legs weren’t warm, there was no redness, and she didn’t remember hitting or hurting the leg in any way but, it was noticeable that with any movement it made her jump in pain.
- Throughout her time in therapy we would put her in the calf buddy to help stretch out her hamstring and we would stand her up. She would have a little pain with that but that day, you couldn’t even move the leg without her jumping in pain. I didn’t do the ultrasound that day because I knew something wasn’t right. When I got the nurse, she talked about how the resident was getting an x-ray.”
The day after the PTA knew “something wasn’t right,” another therapist worked on the resident. This therapist also noted that she didn’t complete an ultrasound because an x-ray for the left hip and knee were ordered.
When a resident is injured in a nursing home, the facility is expected to care for this injury quickly and effectively. Otherwise, this could put the resident at a higher risk of discomfort and long-term disability if the health problem is not dealt with. The Director of Nursing and Regional Director of Clinical Services (RDCS) both confirmed the x-ray that was ordered for the resident was not done. According to the RDCS, “usually the nurse who sees the doctor writing the order will input the order or the nurse on the next shift will see the order flagged and input it into the computer.” The Director of Nursing then said, “the order was never put into the computer and we have to get better about inputting orders.” It is imperative that nursing home facilities follow protocol in order to care for the health and safety of all residents.
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During this difficult time of quarantine, self-isolation, and social distancing throughout Florida and the nation, we want you to know that there are ways to check on any loved ones in a nursing home facility. While you likely won’t be able to visit in person, below are a few tips for checking on your loved one to make sure they are getting the care they need.
- Call every day. Set a time to catch up with your loved one, even if it’s just a five minute call. If your loved one is tech-savvy and uses FaceTime, check in that way! Just one call can help ensure your loved one is still getting the care you expect from the nursing home.
- Call after each shift. Find out when each shift starts and ends, and talk to the nurses after each shift to check on the consistency and quality of your loved one’s care.
- Find out what you can or can’t do. During this time, most nursing homes won’t permit you to enter the nursing home facility in order to protect you and your loved ones. Some, however, let families enter when the loved one is on hospice. Be sure to clarify the rules with the facility so you can plan for any situation.