Failure to Ensure Staff Competency in Advanced Directives and Radiology Procedures
Penalty
Summary
The facility failed to ensure that nursing staff demonstrated appropriate competencies in the implementation of advanced directives and acted within their scope of practice. In one instance, a resident with diagnoses including COPD, dementia, prostate cancer, hypotension, and hypertension with congestive heart failure was documented as Full Code, meaning all life-saving measures should be implemented if cardiac arrest occurs. When this resident was found without vital signs, two LPNs did not initiate CPR and instead pronounced the resident dead, which is outside their scope of practice and contrary to facility policy and state regulations. Both LPNs had current CPR certifications, and one acknowledged in an interview that she should have performed CPR regardless of family wishes due to the Full Code status. The facility policy required staff to provide basic life support in accordance with the resident's advanced directives, and state law specifies that LPNs are not authorized to pronounce death. In another case, the facility failed to ensure staff were knowledgeable about procedures for obtaining and acting on radiology results. A resident with multiple diagnoses, including heart failure and a history of cancer, reported severe hip pain and received a stat X-ray order. Although the X-ray was completed and the results were available within an hour, the facility did not receive or act on the results until the following day. The DON confirmed that the results should have been followed up within four to six hours, and the nurse on duty reported not knowing where else to check for the results beyond the medical record system. The delay in receiving and acting on the X-ray results was attributed to a lack of staff knowledge regarding the facility's procedures for obtaining radiology reports. These deficiencies were identified through medical record review, staff interviews, review of job descriptions, educational consultation forms, and facility policy. The incidents affected two of four residents reviewed for staff competencies, with a facility census of 79 at the time of the survey.