Bridgeview Health Care Center Facility I.D. Number: 0037358 Date of Survey: 09/11/2003 Complaint Investigation "A" VIOLATION(S): The facility shall notify the resident’s physician of any accident, injury or significant change in a resident’s condition that threatens the health, safety or welfare of a resident, including, but not limited to, the presence of incipient or manifest decubitus ulcers or a weight loss or gain of five percent or more within a period of 30 days. The facility shall obtain and record the physician’s plan of care for the care or treatment of such accident, injury or change in condition at the time of notification. The facility must provide the necessary care and services to attain or maintain the highest practicable physical, 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. General nursing care shall include at a minimum the following and shall be practiced on a 24-hour, seven-day-a-week basis: All treatments and procedures shall be administered as ordered by the physician. 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. These regulations are not met as evidenced by: Based on closed record and interviews, facility failed to implement care for R2 who was displaying signs and symptoms of hyperglycemia (elevated glucose levels) for five days and as a result, R2 was transferred to an acute care hospital with the diagnosis of hyperglycemia coma. Findings Include: Review of R2's closed records, R2 was admitted to the facility on 10/15/2001 with the diagnosis which includes fracture of the left leg and diabetes. Review of R2's assessment reveals R2's cognitive level was assessed at a level 2, meaning moderately impaired. R2's physician notes dated 10/22/2001, indicates R2 needs accucheck and blood testing to continue to monitor R2's diabetic condition. Physician orders dated 10/22/2001 states the following; Accucheck Mondays and Thursdays twice a day, HBA1c, (evaluating the glucose in the blood) this month and then every three months. According to the nursing medication assessment record medication administration record (MAR) reveals R2's accucheck, blood glucose levels were above normal for five days and no intervention was implemented. The MAR accucheck reading reveals the following; on 11/08/2001 at 6:00 a.m., results were 250, 11/08/2001 at 4:00 p.m. results were 359, 11/12/2001 at 6:00 a.m., results were 302 and then on 11/12/2001 at 4:00 p.m., reading was not done according to documentation. The normal blood glucose levels are between 60 to 120. Night nursing notes dated from 11/10/2001 to 11/13/2001, reveals R2 slept at long intervals. According to the nurses’ notes, this was very unusual for R2 to sleep at night. R2 would be up at night yelling, screaming and trying to get out of bed. Precautions were implemented to prevent R2 from falling out of bed at night. Frequent checks of supervision were done on R2 because of the unpredictable behavior displayed by R2 at night. During interview with E1 (Director of Nursing) on 09/10/03 at 3:30 p.m. in the conference room, E1 told surveyor she remembered R2. R2 was a very noisy resident and needed strict supervision. E1 also told surveyor R2 was constantly at the nursing station because of her unpredictable behavior, yelling and hitting on her cast and trying to get out of her chair. This was on a continuous basis everyday and night. During interview with E2 (staff nurse) on 09/10/2003 at 2:00 p.m. in the conference room, E2 told surveyor she remembers R2 because R2 was very wild. E2 also told surveyor she was the transferring nurse that transferred R2 to the hospital on 11/13/2001 because of lethargy (symptoms of weakness) and dehydration. E2 further went on to tell surveyor she did not document R2's evening blood glucose but does not remember why. E2 cannot say for sure if the blood glucose was even done because it was about two years ago. E2 also told surveyor she was not aware of the previous blood glucose levels and does not know or understand how or why more attention was not paid to these critical glucose levels. During a phone interview with Z2 (attending physician) on 09/11/2003 at 11:20 a.m., Z2 told surveyor after review of R2's clinical records, he says R2 was in the facility for about six weeks and the last week, R2's glucose level slowly rose to the 200's to 300's range. Z2 also told surveyor the last two to three days R2 was in the facility, she was getting worse but the facility decided to back-up (hold) the psychotropic drugs to evaluate if the psychotropic medications were causing the symptoms. Z2 further went on to tell the surveyor, looking back, they (the facility) probably did not understand other aspects (illness) of being diabetic and not just looking at the psychiatric concerns. |