Failure to Document and Plan for Cardiac Pacemaker Use
Penalty
Summary
The facility failed to ensure quality of care for a resident with a cardiac pacemaker. The resident, who has a history of heart disease and heart failure, indicated that her pacemaker device alerts the facility when fluid accumulation is detected in her body, prompting adjustments to her Lasix medication. However, a review of her clinical records revealed no physician orders or care plan addressing the presence and management of the pacemaker. The resident's diagnoses included acute on chronic heart failure and paroxysmal atrial fibrillation, and her admission records noted a history of heart ablation and an AICD. During an interview with the Director of Nursing and the Nursing Home Administrator, it was confirmed that the facility was unaware of how the pacemaker device communicates with the monitoring company or the necessary emergency procedures to ensure its continued functioning during utility interruptions. The device was not included in the resident's plan of care, indicating a lack of comprehensive documentation and planning for the resident's cardiac needs.
Plan Of Correction
1. Resident 68 care plan, orders were updated to reflect the pacemaker being present. 2. There are no other current residents in the Center with a pacemaker who would be affected by the deficient practice. 3. Nursing staff will be educated on 483.25 and making sure that resident with cardiac medical devices are care planned and ordered. 4. DON/Designee will do an audit weekly x4 and monthly x3 to assure that any residents with pacemakers have orders and care plans as appropriate. Results of the inspections will be submitted to the QAPI team. 5. Date of compliance 1/30/25.