Failure to Respond to Resident's Acute Pain and Requests for Hospital Transfer
Penalty
Summary
A resident who was cognitively intact and dependent on staff for mobility and toileting experienced acute pain and repeatedly requested to be sent to the hospital. Over the course of the night and morning shifts, multiple staff members, including CNAs and a housekeeper, observed the resident in distress and reported his condition and requests for help to nursing staff. Despite these repeated reports, the LPN on the night shift and the RN on the morning shift failed to adequately assess the resident, provide timely interventions, or notify a physician of the resident's change in condition. The resident's pain and requests for hospital transfer were dismissed or ignored, with staff making comments that minimized the resident's complaints. The resident's medical record indicated a history of constipation, with a recent KUB scan confirming constipation and ineffective results from prescribed stool softeners and laxatives. The resident had not had a bowel movement for several days, and there was no documentation of new interventions following the scan results. On the morning in question, the resident was observed screaming in pain, and his family member, after being on the phone with him for over 45 minutes, called the facility directly to demand that he be sent to the hospital. Only after this intervention from the family and notification to facility management was the resident transferred to the hospital, where he required operative intervention for a severe fecal impaction and was diagnosed with gallbladder cancer. Interviews with staff revealed that the resident's pain and requests for help were widely known throughout the facility, yet the nurses responsible did not take appropriate action. The LPN did not assess vital signs or notify the physician, and the RN delayed seeing the resident, prioritizing medication pass and expressing frustration at the resident's repeated calls for help. The lack of timely assessment and intervention resulted in prolonged pain and delayed treatment for the resident.