Failure to Honor Hospice Resident’s Request for Hospital Transfer and Participation in Care Decisions
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident was informed about and allowed to participate in decisions regarding her care and treatment, including her right to request hospital transfer. On the reported date, the resident (R6) stated she experienced shortness of breath and coughing severe enough that her chest hurt and asked the assigned nurse (V17) to send her to the hospital. According to R6, the nurse refused, telling her she was on hospice care. R6 then had her roommate call 911. The roommate (R1) corroborated that R6 was short of breath and coughing, that R6 asked her to call 911 because the nurse would not, and that the nurse said R6 was on hospice and her condition was not bad enough to warrant hospital transfer. The nurse (V17) reported that R6 was uncooperative and refusing care, had a small cough, and wanted to be transferred to the hospital. V17 stated she informed R6 she did not need hospital transfer for a cough, did not call hospice or arrange an emergency transfer, and instead attempted to administer cough medication, after which 911 arrived and transported R6 to the hospital. The DON (V2) stated she expects hospice to be called for a change in condition, that nurses should use PRN medications and interventions, and that if a resident insists on going to the hospital it is their right to be transferred. Record review showed R6 had diagnoses including chronic kidney disease, diabetes, GERD, acute embolism and thrombosis, anxiety, malignant pericardial disease, and was on DNR/comfort care with hospice services and orders for respiratory medications for SOB. Documentation also showed a prior hospital admission for SOB and a hospital record noting acute COPD with bilateral wheezing. The facility’s Resident Rights policy states that the facility will accommodate resident needs and preferences to maintain dignity and well-being, except when it endangers health or safety.
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