Failure to Provide Comfort Care and Timely Symptom Management During End-of-Life
Penalty
Summary
A deficiency occurred when the facility failed to provide comfort care in accordance with an individual's personalized care plan during the dying process. The resident, who had diagnoses including cancer, COPD, respiratory failure, and anxiety disorder, was on hospice care and had intact cognition. Orders were in place for medications such as Ipratropium-Albuterol for shortness of breath, Morphine Sulfate for comfort, and Lorazepam for anxiety. On the evening of the resident's death, she experienced significant shortness of breath, anxiety, and distress, as reported by family and friends present at the bedside. The resident was observed to be panicked, gasping for air, and repeatedly asking for help, but staff did not provide additional interventions to alleviate her symptoms. Documentation and interviews revealed inconsistencies in the administration and follow-up of comfort medications. Progress notes indicated that Morphine Sulfate and Lorazepam were documented as administered at specific times, but surveillance video and controlled substance records did not corroborate all instances of administration. There was also a lack of follow-up documentation regarding the effectiveness of the medications given. The primary nurse did not re-enter the resident's room to assess her comfort after administering medications, and there was no documented assessment of the resident's condition or response to interventions during her final hours. Despite care plan interventions requiring close observation for pain and anxiety, prompt administration of medications, and coordination with hospice for breakthrough symptoms, these actions were not consistently carried out. Family members and friends reported that their requests for additional comfort measures were not addressed, and hospice was not contacted in a timely manner regarding the resident's distress. Facility policies required immediate communication with hospice and thorough documentation of pain management, but these standards were not met, resulting in the resident experiencing unaddressed anxiety and fear during the dying process.