Failure to Communicate with Nonverbal Resident During Care
Penalty
Summary
A deficiency was identified when a respiratory therapist (RT) failed to treat a resident with respect and dignity by not communicating with him while providing care. The resident involved was a male with multiple complex medical conditions, including obstructive hydrocephalus, neuromuscular scoliosis, chronic respiratory failure with hypoxia, anoxic brain injury, spastic quadriplegic cerebral palsy, and obstructive sleep apnea. He was nonverbal, rarely understood by others, had severely impaired memory and decision-making skills, and was totally dependent on staff for activities of daily living. His care plan specifically required staff to converse with him during care and to provide means of communication and reassurance to decrease anxiety. During an observed incident, the resident's oxygen and heart rate monitor began alarming while a respiratory therapist was present in the room with his roommate. Another RT (RT C) was called in to assist. RT C entered the room, quickly donned personal protective equipment, and proceeded to lift the resident, adjust his position, and perform tracheal suctioning without speaking to or explaining the care to the resident at any point. After completing the procedure and replacing the pulse oximeter, RT C left the room, still having not communicated with the resident during the entire episode. Interviews with RT C, the DON, and the Administrator confirmed that staff are expected to knock, introduce themselves, and explain care to residents, even in emergency situations. RT C acknowledged that she did not think about talking to the resident during the urgent situation. The DON and Administrator both stated that staff are regularly in-serviced on the importance of maintaining resident dignity through communication, but also noted that it can be challenging when residents are unable to respond. The facility's policy required residents to be treated in a manner that supports their dignity, but did not specifically address communication during care.