Failure to Escort and Appropriately Manage Cognitively Impaired Resident for Outside Appointment
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate care and services, including an escort, for a cognitively impaired resident during an outside medical appointment, as required by contract and facility expectations. The facility had a care agreement with an outside agency stating that providers would furnish medically necessary services authorized under the agreement. The resident had diagnoses of dementia, emphysema, and PTSD, and a BIMS score of 0.0 indicating severe cognitive impairment. Review of the clinical record showed a nursing note documenting the resident’s return from an appointment with no new orders, but there was no documentation of the time he left the unit, and his appointment was not entered on his calendar in the health record. On the day of the appointment, the outside transport driver arrived at the facility, picked up the resident, and transported him to the outpatient center without a facility escort. Staff interviews revealed that the unit secretary recalled hearing that the resident’s wife would attend the appointment but could not identify the source of this information. The nurse unit manager acknowledged speaking with the resident’s wife afterward, when she expressed upset that no escort had accompanied him, and also acknowledged that staff do not always document the time residents leave for appointments. The assistant DON stated the resident left the unit around midday, but the exact time was unknown, and confirmed that the appointment was not on the resident’s calendar and that a note documenting departure time should have been written. At the outpatient center, the resident was dropped off at the entrance, greeted by staff or volunteers, and brought to the registration area for his CT scan. During the process, he became agitated, asked where his wife was, and displayed confusion and belligerence, ultimately refusing the scan. Outpatient staff contacted his wife, who reported she was not at the appointment and had not arranged to attend, and stated that someone from the facility should have accompanied him. The outpatient center case manager later emailed the NHA, stating that the resident had been sent without a staff escort, that the CT scan could not be completed, and reiterating the policy that residents transported by the outside agency must have an escort from the facility unless a family member is arranged to meet them. The email also relayed the spouse’s concern that the resident had been sent wearing only a thin jacket in 10-degree weather. The NHA confirmed that the resident did not have an escort, that staff believed the wife would meet him, and that he expected cognitively impaired residents to be escorted, with proper documentation of departure and return times and appropriate clothing for outside appointments.
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