Other·October 15, 2021

F777 §483.50(b)(2) The facility must— (i) Provide or obtain radiology and other diagnostic services only when ordered by a physician; physician assistant; nurse practitioner or clinical nurse specialist in accordance with State law, including scope of practice laws. (ii) Promptly notify the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist of results that fall outside of clinical reference ranges in accordance with facility policies and procedures Title 22 § 72311. Nursing Service - General. (a) Nursing service shall include, but not be limited to, the following: (1) Planning of patient care, which shall include at least the following: (A) Identification of care needs based upon an initial written and continuing assessment of the patient's needs with input, as necessary, from health professionals involved in the care of the patient. Initial assessments shall commence at the time of admission of the patient and be completed within seven days after admission. (B) Development of an individual, written patient care plan which indicates the care to be given, the objectives to be accomplished and the professional discipline responsible for each element of care. Objectives shall be measurable and time-limited. (C) Reviewing, evaluating and updating of the patient care plan as necessary by the nursing staff and other professional personnel involved in the care of the patient at least quarterly, and more often if there is a change in the patient's condition. (2) Implementing of each patient's care plan according to the methods indicated. Each patient's care shall be based on this plan. (3) Notifying the attending licensed healthcare practitioner acting within the scope of his or her professional licensure promptly of: (A) The admission of a patient. (B) Any sudden and/or marked adverse change in signs, symptoms or behavior exhibited by a patient. § 72523. Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. The facility failed to notify a Resident 1’s physician of X-ray (an imaging device that creates pictures of inside the body) result after a fall. Resident 1 had an age-indeterminate (not sure how long ago it occurred) moderately displaced subcapital (the bone crack extend through the head and neck of the thighbone and was moved out of its original position) fracture of the left femoral neck (broken bone on the upper portion of the thighbone near the hip). As result, Resident 1’s care and treatment were delayed for the left hip fracture. Resident 1's X-ray was reported, on 3/29/2021 at 10:41 a.m. and was ordered after Resident 1 had an unwitnessed fall, on 3/28/2021 at 7:30 p.m. Resident 1's physician was notified of Resident 1's X-ray indicating a left hip fracture (broken bone) on 3/30/2021 at 7:23 a.m. (31 hours and 53 minutes after her fall). A review of Resident 1's Admission Record indicated the facility admitted Resident 1, 93 year old, on 3/23/2021, with diagnosis that include atrial fibrillation (an irregular, often rapid heart rate that commonly cause poor blood flow), heart failure (heart muscle does not pump blood well), hypertension (chronic abnormally elevated blood pressure), multiple pressure ulcers (injury to the skin and underlying tissue resulting from prolonged pressure to the skin), cataract (blurry vision), osteoporosis (condition that causes the bones to become weak and brittle), hypothyroidism (a common condition where the thyroid doesn't create and release enough thyroid hormone into your bloodstream causing feeling of weakness and tiredness), and abnormalities of gait (a manner of walking) and mobility. A review of the Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 3/25/2021, indicated Resident 1's cognitive skills for daily decision making (ability to think, reason and process information) was moderately impaired. The MDS indicated that Resident 1 required extensive assistance (resident involved in activity; staff provide weight bearing support) with bed mobility, dressing, and personal hygiene. Resident 1 was totally dependent with two staff assistance for transfers and one staff assistance for toilet use. A review of Resident 1's Care Plan for at risk for spontaneous pathological (caused by or involving a disease) fracture related to osteoporosis, and at risk for sudden acute pain to any extremity, swelling and tenderness to area, and guarded on affected movement, dated 3/25/2021, indicated care plan interventions that included X-ray as ordered and inform the physician (MD) of abnormal findings. A review of Resident 1's, Licensed Nurses Notes by Licensed Vocational Nurse 1 (LVN 1), dated 3/28/2021 at 10:33 p.m., indicated that the certified nursing assistant (CNA) reported Resident 1 had an unwitnessed fall at 7:30 p.m. (on 3/28/2021 inside the Resident 1's room. Resident 1 was found on her right shoulder and her right side (on the floor). Resident 1 had no complaints of pain or discomfort and had no bump on the head. The note indicated Resident 1 rolled out of her bed. Resident 1's attending physician (Physician 1) was notified (of the fall) at 7:40 p.m., and Physician 1 ordered X-rays to the right-side upper extremities and lower extremities to rule out possible fracture (broken bones) due to status post (after) fall. A review of Resident 1's physician order, dated 3/28/2021 at 11:07 p.m., indicated a telephone order for Resident 1 to have an X-ray to the right upper extremities and right lower extremities 2 views to rule out possible fracture due to status post fall. A review of the report for the result of Resident 1's X-ray of the right shoulder and hip with or without pelvis (hip area) 2-3 views, dated 3/29/2021 at 10:41 a.m., indicated the resident's right shoulder and right hip had no fracture, and the resident had age-indeterminate (not sure how long ago it occurred) moderately displaced subcapital (the bone crack extend through the head and neck of the thighbone and was moved out of its original position) fracture of the left femoral neck (broken bone on the upper portion of the thighbone near the hip). A review of Resident 1's Licensed Nurses Notes dated 3/30/2021 at 7:20 a.m., indicated that the licensed nurse (not identified) was unable to fax the X-ray report (to the resident's physician), attempts failed three times, and the licensed nurse called Physician 1's exchange (answering services). A review of Resident 1's Licensed Nurses Notes dated 3/30/2021 at 7:23 a.m., indicated Resident 1's X-ray result was reported to Physician 1, and Physician 1 gave new orders to transfer the resident to General Acute Care Hospital 1 (GACH 1). Resident 1 was transferred after 31 hours and 53 minutes of her fall. During an interview on 7/9/2021 at 10 a.m., LVN 1 stated she went into Resident 1's room (on 3/28/2021), and Resident 1 was laying on the floor on her right side with her head on her shoulder. LVN 1 assessed Resident 1, and Resident 1 was able to move all her extremities and had no complaint of pain. LVN 1 stated Resident 1 verbalized that she rolled out of the bed. LVN 1 notified Physician 1 of the fall (on 3/28/2021) and X-ray was ordered for the upper and lower extremities (legs and arms). LVN 1 stated the facility's contracted X-ray company was not available until the next day (3/29/21) to take the X-ray. LVN 1 stated Physician 1 was notified regarding X-ray could not be done until tomorrow, and Physician 1 had said that was, "Fine." During an interview, on 7/14/2021 at 4:30 p.m. Registered Nurse 1 (RN 1) stated she remembered getting the X-ray results on (on 3/29/2021) during her shift (11 p.m. - 7 a.m.). RN 1 stated she tried to fax the X-ray results three times to Physician 1, but the X-ray results would not go through, so RN 1 called the Physician 1. During an interview on 8/31/2021 at 2 p.m., the Director of Nursing (DON) stated if the X-ray results are found to have any abnormalities, the nurse must call physician as soon as possible. A review of facility's policy and procedure for Laboratory and Diagnostic Test Results - Clinical Protocol, revised date 11/2018, indicated the staff who first received or reviewed the lab and diagnostic test result or another nurse (if first staff was not able) should follow or coordinate the procedure (lab. and diagnostic test result protocol). The nursing staff was to prepare and review information that included details of any recent changes, major diagnoses, current medications, and assess a condition change or recent onset of signs and symptoms. The nurse will identify the urgency of communicating with the attending physician. The facility failed to notify a Resident 1’s physician of X-ray (an imaging device that creates pictures of inside the body) result after a fall. Resident 1 had an age-indeterminate (not sure how long ago it occurred) moderately displaced subcapital (the bone crack extend through the head and neck of the thighbone and was moved out of its original position) fracture of the left femoral neck (broken bone on the upper portion of the thighbone near the hip). As result, Resident 1’s care and treatment were delayed for the left hip fracture. Resident 1's X-ray was reported, on 3/29/2021 at 10:41 a.m. and was ordered after Resident 1 had an unwitnessed fall, on 3/28/2021 at 7:30 p.m. Resident 1's physician was notified of Resident 1's X-ray indicating a left hip fracture (broken bone) on 3/30/2021 at 7:23 a.m. (31 hours and 53 minutes after her fall). These violations, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of the residents.