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Dr. Andrew Rynne

Family Physician

Exp 50 years

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I am a nursing home RN with a question regarding

I am a nursing home RN with a question regarding a recent case: I recently had a dialysis patient who was very confused, had just had open heart surgery to replace his heart valves related to complications from endocarditis, and had sustained a rt malleolar fracture that was treated with a plaster cast. At the time of cast placement the ortho surgeon stated in his dictation that surgery to repair the fracture was indicated, but wasn't performed, I assume due to the patient being considered a poor candidate for surgery. The patient came to us with a necrotic areas on his foot under his cast, and removal of the cast at a follow up appointment revealed an unstageable pressure injury to the affected ankle. The patient was returned to us in an aircast that he kept taking off, and eventually his fracture worsened to a compound fracture with exposed bone in the necrotic area of his ankle. It was agreed upon by the nursing staff the resident should be seen in the emergency room but he was sent via facility transfer protocol (about a 45 minute paperwork process) rather than via an emergency transfer. Given the chronic condition of this patient and the already compromised circulation to the affected foot as evidenced by the necrotic areas, does this 45 minute transfer timeframe constitute a delay in care?
Wed, 24 Oct 2018
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