F0580

D

Failure to Notify Physician and Follow Up on Persistent Vomiting and Pain

Hartford, Connecticut Survey Completed on 01-05-2026

Penalty

Fine: $32,295

Summary

The deficiency involves the facility’s failure to follow its change in condition and physician notification policy for a resident who experienced ongoing vomiting, abdominal pain, and non-verbal signs of distress. The resident had diagnoses including chronic respiratory failure, sepsis, and heart failure, and was admitted with bowel and bladder incontinence and an indwelling Foley catheter. Orders included PRN Milk of Magnesia (MOM) and Bisacodyl for constipation, and later Ondansetron for nausea and vomiting. After the resident vomited, Ondansetron was administered and an abdominal scan showed diffuse constipation without obstruction. The APRN ordered MOM in prune juice and a suppository. However, the MAR did not show administration of MOM as ordered earlier, and there was no documentation of the effectiveness of either MOM or Bisacodyl.

During the evening and night shifts, multiple staff members were aware of the resident’s vomiting and abdominal pain, but the response and documentation were incomplete and not consistently escalated. A nursing assistant reported initial vomiting to an LPN, and the nursing supervisor obtained orders for diagnostic imaging and Ondansetron. Later, the resident vomited multiple times again, and the LPN believed the resident should be transferred to the hospital, administered MOM around midnight, but did not document this administration or its outcome. The nursing supervisor on the night shift reviewed the KUB results, obtained orders for MOM and a suppository, and reported that these were administered by the LPN. The supervisor also reported that the resident refused transfer to the hospital.

Despite ongoing symptoms, including dry heaving, repeated vomiting, and later groaning and moaning with eyes closed, there was no timely notification to licensed nursing staff of these later changes, and no documented follow-up assessment of the effectiveness of the PRN interventions. The nursing assistant who observed dry heaving and non-verbal signs of pain at approximately 3:00 AM and 6:45 AM did not notify a nurse. The APRN stated that if PRN medications were ineffective or symptoms persisted, the physician or APRN should have been contacted for additional evaluation and orders, and that the resident had standing orders for Tylenol that could have been used for pain. The DNS indicated that new onset moaning/groaning could be a sign of pain requiring nurse notification and that follow-up after MOM administration should occur within a timeframe based on the resident. The facility’s policy required that significant changes in condition be assessed, documented, and reported to the physician, with new orders obtained and documented, which did not occur in this case.