Failure to Timely Assess and Intervene After Resident Chest Pain Complaint
Penalty
Summary
A deficiency occurred when staff failed to provide timely assessment and intervention after a resident with a significant cardiac history complained of chest pain. The resident had diagnoses including hypertension, nonrheumatic aortic stenosis, and a history of cerebrovascular accidents, and was care planned for altered cardiovascular status. The care plan directed staff to assess for chest pain with every interaction and to notify the provider in the event of a change in condition. On the day in question, the resident exhibited symptoms such as chest pain, lethargy, decreased appetite, and was not acting like herself, as reported by multiple CNAs to the assigned LPN. Despite repeated reports from CNAs that the resident was experiencing chest pain, appeared pale, lethargic, and was not her usual self, the LPN did not perform timely or thorough assessments, delayed taking vital signs until later in the day, and did not notify the provider of the resident's change in condition. The LPN administered an inhaler and acetaminophen but did not document provider notification or further assessment between early afternoon and the evening. The resident's condition deteriorated throughout the day, with staff noting she was difficult to arouse and had not eaten, drunk, or voided. When the evening LPN came on shift and was informed of the resident's status, she immediately assessed the resident, found her unresponsive to verbal stimuli, and called for emergency services. The resident was subsequently hospitalized for a myocardial infarction, as confirmed by elevated troponin levels and hospital records. Interviews with staff and review of facility policy confirmed that the required assessments and provider notifications were not completed in a timely manner, leading to a delay in appropriate care for the resident.