Is this gross negligence?

[Chad_KY_SRNA]

Yesterday at 1500 a CNA noted coldness and dark discoloration to the RLE of a resident on the unit, the DON was the only nurse he could find at that time, she assessed the foot at that time. That residents doctor was in house at 1600 for rounds on his patients but nothing was documented and the doctor was not informed of the coldness and discoloration. At 2200 while performing a routine bedcheck the resident complained of pain to the CNA from earlier in the day. At this time I had not personally been in the room but had overheard the other CNAs talking about the foot earlier and went in to see what the problem was. The residents foot was cold, a dark purplish black color, pulses went from strong to absent. Obviously cap refill was horrible. I told them that I would be right back that I was going to go light a fire under someones butt that it looked like a blood clot to me. The unit nurse came in assessed the foot and sent the resident out to the ER. As far as I can tell from the other CNAs the residents foot had been this way the whole time and the DON did nothing. We looked in the chart and shift report book but there was nothing. I don't even know how to begin to deal with this. The DON saw the foot and the unit nurse knew that it was discolored, cold, and painful to the resident from what the CNAs were telling her, I feel that someone needs to be held responsible for allowing this to fall through the cracks for seven hours until I, as a CNA, saw the foot and went and drug a nurse into the resident room.

[Jolie, BSN]

Yesterday at 1500 a CNA noted coldness and dark discoloration to the RLE of a resident on the unit, the DON was the only nurse he could find at that time, she assessed the foot at that time. That residents doctor was in house at 1600 for rounds on his patients but nothing was documented and the doctor was not informed of the coldness and discoloration. At 2200 while performing a routine bedcheck the resident complained of pain to the CNA from earlier in the day. At this time I had not personally been in the room but had overheard the other CNAs talking about the foot earlier and went in to see what the problem was. The residents foot was cold, a dark purplish black color, pulses went from strong to absent. Obviously cap refill was horrible. I told them that I would be right back that I was going to go light a fire under someones butt that it looked like a blood clot to me. The unit nurse came in assessed the foot and sent the resident out to the ER. As far as I can tell from the other CNAs the residents foot had been this way the whole time and the DON did nothing. We looked in the chart and shift report book but there was nothing. I don't even know how to begin to deal with this. The DON saw the foot and the unit nurse knew that it was discolored, cold, and painful to the resident from what the CNAs were telling her, I feel that someone needs to be held responsible for allowing this to fall through the cracks for seven hours until I, as a CNA, saw the foot and went and drug a nurse into the resident room.

I don't know what the DON did or did not do, so I can't say whether she was negligent or not. Did you document your evaluation of the resident's foot and your notification of the DON? I would advise you to file an incident report with a clear, objective description of the sequence of events as you know them, and ask the other CNAs to do the same. I personally think it is also advisable to keep a private record in a note book at home, in case the incident report should mysteriously disappear. Should any legal action come about as a result of this incident, you will be able to refresh your memory as to exactly what happened.

[Chad_KY_SRNA]

CNAs are not allowed to chart in the resident charts so there is no documentation that the other CNA told the DON anything. I have begged for some form of documentation in the past but unfortunately the managers have done nothing.

[maturner]

"The residents foot was cold, a dark purplish black color, pulses went from strong to absent. Obviously cap refill was horrible. I told them that I would be right back that I was going to go light a fire under someones butt that it looked like a blood clot to me."

I applaud your assessing the situation and looking out the the best interest of the resident. However; as a teaching point, a DVT will usually present as reddened, painful, swollen, good cap refill, and warm if not hot to the touch. Because, there is not a problem with getting blood to the extremity (arterial side) the problem is the blood returning from the extremity (venous side). The problem you describe sounds far more like an arterial issue where there is very little blood flow getting to the extremity secondary to an arterial obstruction such as arteriosclerosis. Poor to no blood flow equals cold, poorcap. refill, purplish black color, etc..

Keep up with the great thorough assessments and remember to always combine the assessment with the clinical picture and utilization of solid critical thinking.

[Chad_KY_SRNA]

The second nurse, the one that acted said "it looks like an arterial blood clot to me". There was little if any swelling present, it was as if there was a tourniquet on the leg at the ankle cutting off blood flow to the foot. I am going to read up on DVT tonight, working a double, again.

[barefootlady, ADN, RN]

Chad,

You answered your own question and you know it. Sure this was neglect. You were given a good piece of advice, write a incident report, keep a written statement of occurance in locked box at home, and do not discuss this incident with any other staff. Do Not Give your opinion on what happened, what was or was not done, and Do Not tell anyone else you are keeping a record on this incident.

[UM Review RN, ASN, RN]

:cheers: PS Great save, Chad!!

[Geeg]

You should be asking the question: Was the standard of care , for similar facilites , met?

[jnette, ASN, EMT-I]

:cheers: PS Great save, Chad!!

I second that !

Good eye.. good heart..good conscience.. good job ! :balloons:

[ceecel.dee, MSN, RN]

Negligent...yes.

But how about the resident that rounded and didn't bother to throw back the bed clothes to eyeball or touch the foot? Equal responsibility???

[ceecel.dee, MSN, RN]

Oops! My bad...resident not informed I see now.

It's all the charge nurse's fault!

[Chad_KY_SRNA]

The local ER diagnosed her with DVT and sent her on to a larger regional hospital for further treatment.