IDPH has cited and fined Generations at Applewood nursing home in Matteson after a resident there had to be hospitalized due to the failure of the staff to follow orders to hold the resident’s blood thinner medication.
Anticoagulant, or blood thinner, medications are an important tool in caring for nursing home residents. They are used to prevent the development of blood clots which can cause heart attacks, strokes, deep vein thrombosis, pulmonary embolisms, and a host of other serious problems. However, this is a medication where the results of the medication have to be monitored very closely. If the blood is “too thick” there is a higher risk of the blood clots developing; “too thin” and there is a increased risk of internal bleeding.
To measure the effectiveness of the treatment, blood tests called PT and INR are done regularly. If the results of the testing shows levels that are too low or too high, it is part of the job to the nurse to notify the doctor of an abnormal lab so that the doctor can issue orders to adjust the dosing of the blood thinner medication.
However, for those orders to be effective, the orders must actually be carried out, and that is where the problem arose here.
The resident at issue was receiving Warfarin, and underwent at PT/INR test. The PT level was 34 (normal level is between 12.5 and 15.1) and and INR level of 3.4 (normal 0.8-3.0). These are both elevated levels, indicating that the blood was “too thin” and that there was an increased risk of internal bleeding.
The nurse on duty called the nurse practitioner who ordered that the blood thinner not be given for 2 days with a repeat test to be performed after that. However, the resident chart does not document any orders to hold the medication or to give the repeat test. As a result, the resident continued to receive her blood thinner uninterrupted for an additional 2 weeks.e
Two weeks later, the staff noticed that the resident had blood in her stool. The doctor was notified and the resident was sent to the emergency room where labs showed elevated PT/INR levels and she was diagnosed with a gastric bleed related to the continued use of the blood thinners. She was admitted to the hospital for treatment.
One of the fascinating things about this citation is that there was no interview of the nurse who communicated with the nurse practitioner. There is no note in the resident chart about what was ordered, which raises a question of exactly what was ordered. Nurse practitioners are generally not direct employees of the nursing home, so this issue would need to be explored carefully before the statute of limitations expires. If the nurse practitioner’s account is correct, then this is a serious issue of substandard nursing care being provided to this resident.
A deeper question would be of course why did the nurse on duty fail to enter the note and order in the resident chart? The answer will likely come back to the she was too busy and simply dropped the ball. Being “too busy” is a hallmark of an understaffed nursing home, and this is a feature, not a bug in the nursing home business model.
One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result. Order our FREE report, Built to Fail, to learn more about why. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.
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