Failure to Provide Comfort, Hydration, and Pain Management for Dependent Hospice Resident
Penalty
Summary
A resident with amyotrophic lateral sclerosis (ALS), chronic pain syndrome, and total dependence for care was admitted to hospice for end-of-life care. The resident's care plan included interventions for comfort, pain management, and hydration, with specific mention of the need for total assistance with meals, snacks, and fluids, as well as monitoring for dehydration. Despite these documented needs and preferences, the resident was left alone behind a closed door, unable to summon help due to physical limitations and the lack of an accessible call light. The resident was observed to be in severe pain, thirsty, and unable to communicate effectively with staff, repeatedly mouthing requests for help and water. Staff actions and inactions contributed to the deficiency. Certified Nursing Assistant (CNA) staff believed the resident was on nothing by mouth (NPO) status, despite there being no physician or hospice order for NPO, and therefore withheld fluids. The resident reported not having received anything to drink since the previous day and was denied hydration measures, even though she was alert and able to tolerate sips of fluid. Pain management was also inadequate, as all routine pain medications were discontinued, and only one as-needed dose of morphine was administered over a two-day period, with no documentation of its effectiveness. The resident reported pain at the highest level and did not receive timely pain relief due to staff prioritizing other tasks. Communication failures were evident, as staff did not notify the resident's physician of her decline or the withholding of fluids, instead only communicating with the hospice provider. The hospice nurse confirmed there was never an order for NPO status and that the resident required a blow call light, which had not been provided. Facility policies required physician notification for changes in condition and supportive measures for hydration and pain, but these were not followed. The resident remained unable to call for help, was left in discomfort, and her preferences and care needs were not met.