Verbal Abuse Incident Involving Resident and LPN
Penalty
Summary
The facility failed to protect a resident from verbal abuse, as observed by surveyors. The incident involved a Licensed Practical Nurse (LPN) who removed a spare oxygen cannula from a resident's room and subsequently engaged in a verbal altercation with the resident. The LPN yelled at the resident from the nurses' station, accusing the resident of being manipulative and dismissing the resident's expressed need for the spare tubing. The resident, who was diagnosed with acute and chronic respiratory failure, chronic obstructive pulmonary disease, and mental health illnesses including anxiety disorder and major depressive disorder, appeared upset and anxious during the interaction. The resident's care plan indicated that the resident required continuous oxygen therapy and had specific interventions to manage anxiety and compulsive behaviors. The care plan also noted the resident's need for a long oxygen tubing to walk in his room and hallway. Despite these documented needs, the LPN's actions and verbal communication did not align with the care plan's interventions, which included anticipating and meeting the resident's needs and providing opportunities for positive interactions. The psychological services notes highlighted the resident's ongoing struggles with anxiety and irritability, with recommendations to manage mental health symptoms more appropriately. The incident observed by surveyors demonstrated a failure to adhere to these recommendations, as the LPN's approach escalated the resident's anxiety rather than mitigating it. The facility's policy on abuse education defines verbal abuse as acts that cause humiliation, shame, or agitation, which were evident in the LPN's interaction with the resident.
Plan Of Correction
The facility immediately educated employee E18 on abuse and suspended E18 pending investigation. LNHA opened event report 1055382. The facility immediately began the investigation by obtaining statements from resident R28, E18 and witnesses. The facility provided Psych services to resident R28. The facility has conducted an abuse training in-service with all staff. The facility will review abuse reporting with residents at Resident Council. The facility will conduct a random sample of 5 residents checking for resident's safety and comfort with staff. The facility will monitor employee training on abuse prevention upon hire and at least yearly thereafter or as needed. The facility will verify that information on how to report abuse is located on resident/visitor areas. The facility will monitor that grievance forms are available on the units for residents to file complaints/make reports. The facility will review and remind residents of the types of abuse and how to report abuse at least every quarter at resident council meetings. Nurse Educator / designee will audit all current staff and new staff's education files for abuse prevention training upon hire and at least yearly, monthly x3 months. Director of Social Services / designee will surveil that advocacy posters and grievances are highly visible in resident/visitor areas weekly x4 weeks then monthly x3 months. Recreation Director / designee will monitor resident council meeting topics and audit resident council meeting minutes to include abuse prevention information to residents monthly x3 months. Findings will be reported to the QAPI committee.