Failure to Report Resident's Change in Condition by CNA
Penalty
Summary
A certified nurse aide (CNA) failed to communicate a resident's complaint of pain to the charge nurse, as required by facility protocol. The incident involved a female resident with a history of vascular dementia, chronic pain, skin cancer, malnutrition, and chronic obstructive pulmonary disease. The resident, who had severely impaired cognition, voiced mild discomfort in her right rib area during a transfer to a shower chair. The CNA did not report this complaint to the charge nurse, assuming that the resident's physician assistant (PA), who had visited earlier, had already been informed of the pain. The CNA stated that she had been regularly in-serviced on the importance of reporting changes in a resident's condition to the charge nurse but did not do so in this instance due to her assumption about the PA's awareness and the resident's lack of further complaints during the shower. The charge nurse and the director of nursing (DON) both confirmed that CNAs are expected to immediately report any resident complaints of pain or changes in condition. The charge nurse was not made aware of the resident's pain until later, when the resident made an allegation of abuse to a nurse practitioner (NP), prompting an assessment and investigation. Subsequent assessments found no visible trauma or injury, and the abuse allegation was determined to be unfounded. However, the failure to promptly report the resident's complaint of pain represented a lapse in ensuring that nursing staff had the appropriate competencies and skill sets to provide care that assures resident safety and well-being. The facility did not have a specific policy related to reporting changes in condition, despite regular in-servicing on the topic.