Failure to Honor Resident’s Request for Hospital Transfer and Delay in Emergent Care
Summary
The deficiency involves the facility’s failure to protect a resident’s right to seek medical services outside the facility, resulting in delayed emergent care. A resident with diagnoses including pancreatic disease, immune disorder, anemia, and muscle wasting had previously undergone a laparoscopic distal pancreatectomy with sphincterotomy and partial gastrectomy. Following admission to the facility, the resident developed symptoms of pain, bloating, vomiting, and later diarrhea after surgery. Progress notes show that on one day in the afternoon, a nurse called and left a message for the MD regarding the resident’s condition, and later that night the resident complained of pain and vomiting, the MD was notified, pain medication frequency was increased, and milk of magnesia was ordered and given. The note also indicated a need to call the MD for IV normal saline to prevent dehydration per family request, but documented that the MD was called with no response. The next day around midday, documentation shows the resident complained of stomach pain and was insisting on going to the hospital, with vital signs recorded as temperature 97.3, pulse 104, respirations 18, blood pressure 173/99, and oxygen saturation 97%. The nurse documented that the doctor was paged to advise. Later that afternoon, staff documented returning from lunch and finding paramedics at the resident’s room, and that the resident had called paramedics to be taken to the hospital. Hospital records from that day show the resident was admitted with a chief complaint of sepsis and suspected pseudocyst, with a history of similar abdominal symptoms and prior imaging showing pancreatic duct stricture and dilation. In interviews, the resident’s family member reported being upset and frustrated because staff did not want to send the resident to the ER despite the resident’s request to go to the hospital after experiencing pain, bloating, vomiting all night, and subsequent diarrhea. The family member stated that a nurse said the in-house doctor would assess the resident first, that the resident had a pail of vomit at bedside, and that the family begged the nurse to send the resident out but she would not. The family member reported calling non-emergency police for a wellness check and advising the resident to call 911 herself, after which the resident was transported. CNAs recalled the resident becoming very sick and throwing up frequently. The DON acknowledged hearing that the resident was sick and that police had been at the facility, and confirmed that if a resident wanted to go to the hospital, the nurse should assess, notify the physician, document vitals and monitoring, and assist the resident in seeking outside medical care. Review of the facility’s Resident Rights policy showed the facility is required to protect and promote residents’ rights, including assisting them in maintaining communication with outside agencies and ensuring they can exercise their rights without interference, coercion, discrimination, or reprisal.
Plan Of Correction
Continued from page 1 Weeks, then monthly for two weeks to ensure timely response to resident requests to go out to the hospital. Audit findings will be reported through the facility's Quality Assurance Committee monthly until substantial compliance is met.
Penalty
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