Failure to Timely Notify Physician of Neurologic Change in Hospice Resident
Penalty
Summary
The deficiency involves the facility’s failure to notify the attending physician in a timely manner of a significant change in condition for one cognitively impaired resident with extensive cerebrovascular and dementia-related diagnoses, including prior TIA, cerebral infarction, Alzheimer’s disease, atrial fibrillation, hemiplegia/hemiparesis, and unspecified dementia. On the day in question, the resident was on hospice care and had a POLST specifying selective treatment, including hospitalization. During the morning shift, a CNA observed that the resident’s face was shifted to the right and that she was not talking, and she reported this to the LPN on duty. The LPN stated she noted the resident was not talking and had her eyes closed, checked vital signs, and called hospice, after which a hospice RN and a family member came to the bedside. The LPN did not notify the attending physician of these changes, despite facility policy requiring physician and family notification for any change in condition. During the same day, the hospice physician reported receiving a call from a female hospice nurse during the morning shift that the resident had “weaknesses,” but he was not informed of facial shifting or drooping to the right side. He stated he was not given detailed information about the change in condition and was unaware that the resident’s POLST allowed for selective treatment including hospitalization. The Director of Nursing later stated that the hospice doctor had been notified and made aware of the change in condition, but this was not documented, and the hospice physician’s account indicated he did not receive full details of the neurologic changes. On the evening shift, the incoming LPN was told by the outgoing LPN that the resident was “not doing good,” but she did not ask whether the attending physician had been notified, citing the resident’s hospice status. During her initial rounds, this LPN observed the resident’s mouth deviated to the right and later fed the resident around dinner time with a family member at the bedside, still without contacting the attending physician. Another family member, an eye surgeon, arrived later that evening, recognized signs of stroke, and requested that the LPN call the attending physician immediately. The physician reported that no staff had informed her of the facial drooping until this family member spoke with her, at which point she ordered the resident sent to the hospital, where the resident was admitted with a diagnosis of stroke due to embolism of the right middle cerebral artery. Progress notes documented that the LPN notified the physician only after the family member’s request.
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