Lack of Staff Competency in Managing Resident’s Deep Brain Stimulator
Penalty
Summary
The deficiency involves the facility’s failure to ensure staff were knowledgeable and competent in the use and monitoring of a deep brain stimulator (DBS) for a resident with Parkinson’s disease. The resident’s face sheet documented diagnoses of Parkinson’s disease and a DBS, and the care plan included an approach to charge the DBS on specified days by placing a round disk on the right side of the chest for approximately two hours or until fully charged. The physician’s orders and the treatment administration record also directed that the DBS be charged three times weekly on night shift. Despite these written directions, the resident reported that staff were supposed to charge his DBS but did not know what they were doing and that sometimes his DBS was not charged. Multiple staff interviews confirmed a lack of formal in-service training and inconsistent knowledge about how to operate the DBS charger, how to verify that it was charging, and what symptoms the resident would exhibit if the DBS was not charged. Several LPNs and an RN stated they had not been inserviced on how to use, read, or charge the DBS device and did not know how to tell if it was charging or what symptoms to look for when it was not charged. One LPN reported learning from the resident’s family and the resident himself, rather than from facility training, and others stated that the family or the resident handled the charging. Staff described various observations when the DBS was not charged, including increased tremors, difficulty swallowing, coughing while eating, delayed or slurred speech, and slow movements, but this knowledge was informal and not based on structured education. Leadership interviews further demonstrated the absence of a systematic training process. The DON, who had been in the role for over ten years, acknowledged she had not inserviced staff on how to use the resident’s DBS and did not know the full extent of symptoms that could occur if it was not charged. The ADON recalled being shown how to charge and read the device by the resident’s family at the time of admission, rather than through a facility-led process. The neurologist’s medical assistant and the medical director both stated that when the DBS is not charged, the resident’s Parkinson’s symptoms increase, such as tremors, slurred speech, shuffling gait, and out-of-control tremors, and both expected staff to be educated on device use and symptoms. A DBS policy dated 1/2013 referenced following manufacturer’s instructions and charging as recommended by the doctor but did not bear the facility’s name, and there was no evidence in the report that this policy had been implemented through staff training.
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