Neglect Or Not

  1. Scenerio

    For past week Resident has been c/o of shortness of breath (SOB). Treated with prn oxygen and nebulizer treatments. Resident c/o chest pain one day as well as SOB at 9:30 AM. Still treated with O2 and Nebulizer Tx. No call to the DOC. DOC make rounds at 6:30 PM. Nurse gets order to send to ER to be evaluated. Doesn't get sent to ER till 5:30 AM the next morning. Resident dies a few hours later. Resident is a DNR. Nurse tried to call the Responsible Party before shipping to the hospital. Didn't reach RP till 1:00 AM. Nurse getting the order left at 1:30 AM without shipping the resident out. ER records show the resident had elevated troponin levels.

    History on the Nurse... Disciplined for not following MD orders 8 months prior to incident. Disciplined 4 months prior for the same thing this time monitored for a month. Nurse worked double shifts. At the time of the incident, Nurse had 95 hours of overtime... yes... 95 hours overtime.

    Oncoming nurse was from an agency. Had worked in the facility before.

    Is this a case of neglect? Are both Nurses responsible? Is the facility responsible as well?

    Comments welcome.
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  2. 10 Comments

  3. by   Youda
    As a matter of standards of care, and prudent nursing, any change in condition must be reported to the MD. That means when the res. first showed signs of SOB, a thorough cardiopulmonary assessment should have been done and the MD notified. If appropriate orders were not received, or there were further changes in condition, the nurse has the legal and moral responsibility to be an advocate for the res. and continue to call the MD or suggest a transfer until appropriate interventions are initiated. Further, a DNR does NOT mean "Do Nothing for Res.". It means you do everything possible up to the time of cardiac or respiratory arrest, unless there are Advance Directive prohibiting certain acts such as antiobiotics, transfers to hospital, etc.

    Not being able to notify the responsible party is not a defense. The nurse takes her orders from the MD, not the RP. The only way out of that would be IF the MD had said to transfer IF the RP concurs. If s/he said just to transfer, it should have been done immediately.

    So, to answer your question. Yes, there was neglect if not malpractice. Astounding neglect. The Board of Nursing and the Division of Aging MUST be notified.

    I sincerely hope you weren't involved in this at all.
  4. by   adrienurse
    Sounds to me like a nightmare. He/she definately did not do their job.
  5. by   Catsrule16
    I handled a complaint investigation for the State Survey Agency regarding this incident. Yes, State Boards were notified by the facility as well as myself. Nurse was teminated. The facility was cited for neglect under F224 at the harm level and for standards of practice at F281 at the harm level. Knew the Nurse as a former co-worker when I worked on the provider side. Was a hard investigation to complete. Had to keep what I knew of her work history in check. This is the second time this Nurse has caused a facility to be cited for neglect. Different facilities though.

    Thanks for your replies!
  6. by   Youda
    The only comfort I can give you is that if people keep reporting this kind of nurse to the BON, eventually it will take her license and the public will be a little safer. You were right to keep her former incidents to yourself. Because if you had mentioned them, and hadn't already reported it, you would have been held legally liable also. I hear many complain about the State and paperwork in LTC. This kind of thing shows why it is so necessary.

    Good wishes to you. I know what you went through wasn't easy. But, you took care of the residents; and sometimes that's all we've got, the knowledge that we did the courageous and right thing.
  7. by   sassynurse78
    This is terrible!! Sometimes I wonder how some folks passed boards. This is scary.
  8. by   ChainedChaosRN
    Catsrule...are you saying you were a surveyor in a facility you formerly worked at? I'm just curious, if this is so, I was under the impression that this was not allowed to happen?
  9. by   Catsrule16
    Yes, I am a surveyor. I never worked at the facility where this happened. I did work with the nurse in question in the past at another facility.

    The state I work in does not allow a surveyor to return to a facility where they worked in the past for 2 years. If a family member no matter how remote, resides in a facility, a surveyor cannot survey that facility for 2 years after the family member has been discharged.

    To date, I have not returned to any of the facilities in the state where I have worked. I have been with the State Agency long enough now to be able to go to ANY facility.
  10. by   ChainedChaosRN
    Thank you Catsrule...I appreciate the info
  11. by   CapeCodMermaid
    If I think a resident is in that much distress and needs to go to the hospital, I'll call the doc and request and order. If it a true emergency, I'll call 911 first, then call the doc and tell them that I am sending the resident out. Only once did a doc tell me to keep the patient at the facility. Once I told him DPH was in the building, he said...OH...send them quick!! My DON backs me up with all these decisions.
  12. by   HARN
    The first c/o SOB should have been reported to the doc, this was a change in the patient condition. Even if the tx made the assessment WNL. Second, the c/o chest pain should have been reported at the time of the complaint. Then the doc could have made the decision upon to send to ER or not. What was the hold up sending the patient? Nine hrs later the patient left for the ER. Despite the patient's DNR order, the RN was NOT resusitating the patient just maintaining life until that point of arrest.
    As far as the RN working 95 hrs of over time....Is this possible?
    I think that both the RN & the facility should be investigated for the happenins of that day.
    The publc trust the staff at a long term facility to take care of there loved ones, with incidents like this to continue, there will be no trust.
    Last edit by HARN on Jun 5, '03

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