Failure to Provide Timely Assessment and Intervention for Suspected Stroke
Penalty
Summary
A deficiency occurred when the facility failed to provide timely and ongoing assessment and intervention for a resident who experienced a change in condition suggestive of a stroke. The resident, with a history of transient ischemic attack (TIA), cerebral infarction, encephalopathy, and hypertension, reported symptoms including tingling in the left arm and inability to grasp with the left hand. The nurse documented these symptoms and notified the nurse practitioner (NP), who assessed the resident but did not identify significant changes or initiate further evaluation beyond recommending increased blood pressure monitoring. There was no evidence that the recommended monitoring was implemented or that the resident was reassessed following the initial change in condition. The resident's family reported concerns to the facility about the resident experiencing stroke-like symptoms and missing scheduled neurology appointments. Despite these reports and the resident's new onset of left-sided weakness, the facility did not send the resident for further evaluation or to the hospital, as confirmed by the Director of Nursing (DON), who stated that the expectation was to send residents out immediately for new stroke symptoms. The DON also confirmed that the facility lacked a stroke protocol or policy and that no follow-up was conducted on the resident's change in condition. The therapy department identified a significant change in the resident's functional ability the day after the initial symptoms, but there was still no reassessment or intervention documented. The resident ultimately missed two neurology appointments before being seen by a neurologist, who then sent the resident to the hospital for evaluation of a suspected stroke. Hospital records indicated a new chronic lacunar infarct on imaging. The facility failed to provide appropriate and timely care in response to the resident's change in condition, as well as to ensure attendance at necessary medical appointments.