Failure to Respond to Significant Change in Condition for Resident With Covid and Atrial Fibrillation
Penalty
Summary
The deficiency involves the facility’s failure to recognize and respond to a significant change in condition for one resident with a known history of paroxysmal atrial fibrillation and a recent Covid-19 diagnosis. The resident’s care plan required staff to notify the physician of any abnormal readings. On a documented date, an RN obtained vital signs and recorded a new-onset irregular heart rate of 111 beats per minute. Despite this abnormal finding and the resident’s cardiac history, the irregular pulse was not reported to the physician or PA, and the resident was not sent out for evaluation at that time. The facility’s Change in Condition Procedure required a full nursing assessment, including full vital signs and evaluation of level of consciousness, respiratory status, abdomen, functional status, and pain, followed by notification of the medical provider, but this process was not followed. Multiple CNAs reported that during the period when the resident was ill with Covid, the resident experienced a rapid decline, including extreme weakness, shortness of breath, inability to feed or care for himself, lethargy, appearing dazed, and repeatedly stating he did not feel well. CNAs V6, V8, and V9 stated they repeatedly reported these concerns and the resident’s change in condition to an LPN and an RN, but the LPN repeatedly stated she was too busy with a medication pass to assess the resident and did not act on their concerns. The RN recalled CNAs reporting a significant change in the resident’s condition and that they had reported it to the LPN, who did not respond. The DON later assessed the resident and sent him to the hospital, where he was diagnosed with Covid-19, acute renal failure, elevated troponin, hyperkalemia, dehydration, and atrial fibrillation with rapid ventricular response. The PA stated that an irregular pulse of 111 in this resident should have been reported or resulted in an emergency room evaluation and that the resident’s clinical picture warranted further diagnostic testing.
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