Failure to Provide Timely Hospital Transfer for Resident with Acute Neurological Changes
Penalty
Summary
A deficiency occurred when the facility failed to ensure that services provided met professional standards of quality for a resident with a history of stroke, peripheral vascular disease, and Parkinson's disease. The resident, who had moderate cognitive impairment and required significant assistance with activities of daily living, experienced a sudden onset of slurred speech. This change was first noted by an LPN, who notified the nursing supervisor and a nurse practitioner (NP). The NP instructed staff to place the resident in bed for rest. Despite continued slurred speech, the NP initially ordered intravenous fluids and lab work, suspecting dehydration, and later requested a speech evaluation. The resident's symptoms persisted into the following day, with ongoing slurred speech and general weakness. The NP was again notified and, after further discussion and at the request of the resident's representative, ordered the resident to be transferred to the hospital to rule out a stroke. The resident was subsequently admitted to the hospital with a diagnosis of bilateral scattered infarcts. Documentation and interviews revealed that the NP and medical director did not immediately suspect a stroke and opted to treat in place, attributing symptoms to possible dehydration or other non-stroke causes. The medical director indicated that unless symptoms worsened or failed to improve, the standard practice was to continue treatment in the facility rather than transfer to the hospital. Interviews with facility staff and the resident's representative highlighted delays in recognizing the severity of the resident's symptoms and in transferring the resident for appropriate evaluation and treatment. The NP did not consult the medical director regarding the case, and the medical director did not question the NP's decisions. The facility's approach did not align with timely intervention for potential stroke symptoms, as required by professional standards of care.