Delay in Emergency Evaluation After Resident Found With Extensive Facial and Body Bruising
Penalty
Summary
The deficiency involves the facility’s failure to promptly obtain medical evaluation and treatment for a resident who was found with multiple bruises and facial trauma, despite a policy requiring immediate physician notification and action for accidents, incidents, or injuries of unknown origin. The facility’s change of condition policy states that the nurse will promptly notify the attending or on-call physician when there has been an accident or incident involving the resident, discovery of injuries of unknown source, or a need to transfer the resident to a hospital or treatment center. On the morning in question, the resident was observed by an RN at approximately 8:21 AM with a bruised and swollen left cheek, dried blood on the teeth and left lip, pain with opening the mouth that prevented medication administration, a light bruise on the left clavicle, and a small bruised knot above the left eye; ice was applied to the left cheek. A subsequent nursing assessment at 9:20 AM documented extensive bruising to the right and left anterior shoulders, left lateral head, forehead, left eyelid, left eyebrow, left cheek, left inner ear, left jaw, anterior neck, left upper chest, right dorsal hand, left first knuckle, left medial wrist, and top lip. Despite these findings, the resident remained in the facility for several hours before being sent to the hospital. The RN caring for the resident from 6:00 AM to 6:30 PM stated that around 7:00 AM a CNA asked if she had seen the resident’s cheek, and by about 7:30 AM, when the resident was in the dining room, the RN observed dried blood on the left side of the lip and teeth, and the resident reported pain with opening her mouth and refused crushed medications. The RN also observed a raised bruised left cheek about the size of a quarter, a raised bruise above the left eye about the size of a dime, a knot on the forehead, and a grey bruise on the left clavicle. Although the RN reported notifying the DON, who then spoke with the resident’s physician to obtain an order to send the resident out, the RN acknowledged that the resident was not sent out right away and that there was a delay until around lunchtime. The medical record shows the order to send the resident to the local hospital for evaluation of facial and clavicle trauma at 11:37 AM, and ambulance notes at 11:59 AM document the resident reporting face and neck pain, with hematoma on the forehead, left facial swelling and bruising, dried blood on the teeth, and bruising on the anterior neck, left side, and left clavicle. The hospital record notes that the nursing home had noticed facial bruising, dried blood in the mouth, and pain with movement in the face and neck.
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