Based on clinical record review, and interviews with residents and staff, it was determined that the facility failed to ensure that a licensed registered nurse maintained professional standards of quality care set forth in the Pennsylvania Code Title 49, Professional and Vocational Standards by failing to accurately convey information to the physician about a resident's change in condition that resulted in a delay in treatment for one of four sampled residents. (Resident 1)
Clinical record review revealed that Resident 1 was admitted to the facility on July 30, 2019, and had diagnoses that included atrial fibrillation, cirrhosis, and anemia. According to the resident's advance directives, she did not wish to be resuscitated if her heart stopped, but otherwise made no other decisions about emergency care.
According to the current plan of care, the facility identified that the resident was at risk for abnormal bleeding due to her medications. The care plan indicated that nursing staff was to monitor the resident for abnormal bleeding (e.g. blood in stools), and notify the physician if abnormal bleeding was present.
On January 23, 2020, a nurse noted that the resident was "bleeding from the rectum" and had "significant blood loss." In an interview conducted on February 6, 2020, at 12:00 p.m., the physician stated that the nurse called him to inform him of the bleeding, however informed him that the resident refused hospitalization and was on "comfort measures" (a status where the resident declined most medical care other than pain management). There was no documentation in the clinical record that the resident was on "comfort measures." In an interview conducted on February 6, 2020, at 10:30 a.m., the resident stated that she never refused to go to the hospital. According to the nurses' notes, the resident was not sent to the hospital until approximately two hours after the onset in symptoms.
In an interview conducted on February 6, 2020, at 12:05 p.m., the Director of Nursing confirmed that the nurse gave the physician inaccurate information, resulting in a two hour delay in treatment at the hospital.
The facility failed to ensure that the professional standards of nursing conduct was maintained in regards to carrying out nursing care actions which promote, maintain, and restore the well-being of individuals in accordance with Title 49, Professional and Vocational Standards, Department of State, Chapter 21.11(a)(4) Responsibilities of the Registered Nurse.
28 Pa. Code 211.12(d)(1)(5) Nursing Services.
Previously cited 6/28/19
| ||Plan of Correction - To be completed: 03/16/2020|
This Plan of Correction constitutes my written allegation of compliance for the deficiencies cited. However, submission of this Plan of Correction is not an admission that a deficiency exists or that one was cited correctly. This Plan of Correction is submitted to meet requirements established by state and federal law.
1. Resident #1 received care at Acute Care Center and was readmitted to facility post treatment for her GI bleed. POLST and Advanced Directives updated to reflect her current requests regarding hospitalization.
2. Residents currently residing in the facility who have a care plan for Advanced Directives have been updated regarding their resuscitative measures and is consistent with the known desires of and in the best interest of the resident. Updated information has been placed on resident's profile for easy access for appropriate staff members.
3. Admissions Office Social Work, and Nursing have been educated on the following:
- Reviewed Advance Directives/POLST on file along with care plan.
- Have had a conversation with the resident regarding her current desires for treatment.
- Relayed accurate information to the resident's physician regarding her physical status.
- Reviewed with Family members and/or Guardian of Resident's current status and desires regarding treatment.
4. Audits will be completed by the Social Service and/or designee weekly for 4 weeks and then bi-weekly monthly for 3 months until compliance is met. Audits will be presented to QA Committee for efficacy of facility systems and interventions for corrective actions if needed.