BURNSIDE NURSING HOME
Facility I.D. Number 0007153
410 N. Second St.
Marshall, IL 62441
Date of Survey 06/01/2000 Complaint Investigation 0062419
The facility must provide the necessary care and services to attain or maintain the highest practicable, mental, and psychosocial well-being of the resident, in accordance with each resident's comprehensive assessment and plan of care. Adequate and properly supervised nursing care and personal care shall be provided to each resident to meet the total nursing and personal care needs of the resident.
Objective observations of changes in a resident's condition, including mental and emotional changes, as a means for analyzing and determining care required and the need for further medical evaluation and treatment shall be made by nursing staff and recorded in the resident's medical record.
AN OWNER, LICENSEE, ADMINISTRATOR, EMPLOYEE OR AGENT OF A FACILITY SHALL NOT ABUSE OR NEGLECT A RESIDENT.
These regulations were not met as evidenced by:
R3's current medical record documents the following: R3 was hospitalized on 05/05/2000 following a Cerebral Vascular Accident (CVA). R3 was admitted to the long term care facility on 05/12/02000. Diagnoses include CVA with right hemiplegia, Expressive and Receptive Dysarthia, and Cataract of the right eye.
R3 has a living will dated 11/19/1991 which directs life prolonging measures to be withheld in the event R3 should have" an incurable and irreversible injury, disease, or illness judged to be a terminal condition" by R3's attending physician, who has determined "death is imminent". R3 also has a Power of Attorney For Property dated 11/19/191991 which delegates authority to Z3. Interview at the facility with Z3 and Z4 at 0110 on 05/25/2000 confirmed none of R3's family have been given Power of Healthcare for R3 and the Surrogate Act has not been implemented.
Review of the Clinical Dysphagia Evaluation completed 05/08/2000 documents a 3 second delayed swallow with pureed foods; a 2-3 second delay with thin liquids per spoon; and a 3 second delay with honey-thick liquids per spoon. The impression of the evaluation was "mod oral dys" with "probable" "pharyn delay"; with a recommendation of "NPO" (Nothing Per Os).
The short term goal lists speech therapy 5 times weekly to improve the oral/motor skills. The rehab potential was listed as "guarded". R3 was receiving Total Parenteral Nutrition in the acute care setting.
Admission nursing assessment dated 05/12/2000 10:00 a.m. lists R3 to be 76 years old with a height of 60.5 inches and a weight of 129 pounds. Admission physician orders prescribed by Z1 and dated 05/12/2000 include: intravenous(IV) fluids of Dextrose and Normal Saline with 20 meq Potassium Chloride to run at 75cc per hour; and "offer sips of clear liquid/nurse with swallow precautions". The intravenous fluids were started at 1430 on 05/12/2000. Z1's progress notes dated 05/13/2000 documents, "Daughter requested (per nurse) we start IV for comfort measure."
Nurse's notes dated 05/13/2000 at 0930 document: "Asked to roll to (R) side et did so." "Took 5cc H20 - 1cc @ a time - instructed to swallow. (no) cough noted."
Nurse's notes of 05/13/2000 1045 documented Z1 had examined R3 and that R3's family were in the process of obtaining a healthcare power of attorney.
Nurse's note of 05/13/2000 2100 document R3's family had visited and "expressed the preference that res. not receive any liquids by mouth, only oral care be done".
Physician's order prescribed by Z1 dated 05/15/2000 reads, "Nurse may give resident Enlive very slowly with 5cc syringe as tolerated." Nurse's note dated 05/15/2000 1420 document R3, "Drank 50cc Enlive clear nutrition this shift. Little sips @ a time. (No) choking noted. (No) verbalization, but follows staff (with) eyes."
On 05/16/2000 a physician's order was received from Z2 for R3, instructing staff to "D/C IV. Oral care only." Nurse's note dated 05/16/2000 2130 documents, "IV DC'd at this time. Resident is awake and alert."
Interview with E1 on 05/25/2000 confirmed that R3's intravenous feeding and oral intake were discontinued on 05/16/2000 based on the physician's order from Z2. Interviews with E1, Z1, Z3 and Z4 on 05/25/2000 all confirmed Z1 did not agree with stopping the IV, so R3's family had requested Z2 to discontinue them. During interview with Z1 on 05/25/2000, Z1 stated Z1 had met with R3's family regarding the discontinuance of the IV fluids and Z1 had told the family "not giving nutrition and comfort measures such as fluids was over-stretching bounds of support", and "it would be reasonable to not discontinue hydration and nutrition."
During interview Z1 confirmed Z1 did not consider R3 to be in a "terminal state".
Nurse's note dated 05/25/2000 0120 documents, "Res had herself uncovered et was rubbing her stomach. Was repositioned. Handed her a doll et she placed it in bed beside her. Oral care given, res sucked H20 out of swab. (No) sign of distress."
Nurse's note dated 05/25/2000 0315 documents, "while oral care being given, res grabbed toothette away from staff placed it in her mouth, sucked the H20 out of it et gave it back to the staff."
Record review and interview with E1 on 05/25/2000 confirmed R3 was maintained NPO without any nutrition or hydration offer from 05/17/2000 until breakfast on 05/25/2000. Review of documentation by E3 and interview with E1 on 05/25/2000 revealed that following consultation with Z5 on 05/24/2000, Z2 and R3's family were consulted and Z2 gave an order to "Offer nutrition and hydration as tolerated. Quality of Life feedings".
Nurse's note dated 05/25/2000 0830 document R3 to consume "1/4 cup applesauce, 90cc H20, 180cc coffee - did well. Fed per spoon and showed no difficulties with swallowing. Did become slightly choked when she held the cup herself and took a drink herself."
R3 was observed at 1150 on 05/25/2000 to be seated in a wheelchair eating lunch. R3 was observed to consume 10 spoonfuls of pureed foods and 50cc Enlive supplement without any signs of choking. R3 would swallow upon cuing from staff. R3 was observed to take the plastic cup of clear liquid from staff's hand and independently drink from it. Although R3 was unable to verbalize, R3 tracked with her eyes and used body language to communicate her dislike of a certain food.