IDPH has cited and fined The Moorings nursing home in Arlington Heights after the nursing staff failed to notify the doctor that a resident was having coffee ground emesis (a sign of internal bleeding) resulting in a delay in the resident obtaining care and the wrongful death of the nursing home resident.
One of the basic truisms about nursing home care is that there is not a doctor in the facility 24/7 like there is in a hospital. Therefore, one of the basic functions of a nurse in a nursing home is to serve as the “eyes and ears” of the doctor. When something happens with one of the doctor’s patients, it is the job of the nurse to notify the doctor that a resident has experienced a change in condition. It isn’t their job to diagnose what the problem is or determine what the right course of treatment for it is; it is just their job to present the problem to the doctor so that the doctor can decide whether to issue orders over the phone, come in to see the patient, or order the patient sent to the hospital. When there is a true emergency situation, the staff should bypass the doctor and
The problem arises when there is a failure on the part of the nursing staff to carry out this function. Without the nurse telling the doctor that something is happening with the patient, the doctor has not reason to know that anything needs to be done to help. When no one steps up to get a nursing home resident help when things go wrong, the situation can escalate rapidly – and that is a formula for disaster in a medically fragile patient population.
The resident at issue had a history of atrial fibrillation which is an irregular heartbeat. This can cause blood clots which can cause a host of complications, most notably a stroke. To combat the development of blood clots and thereby reduce the risk of stroke, people suffering from atrial fibrillation are commonly treated with a blood thinner or anticoagulant, in this case coumadin. He was also on antibiotics for an infection. When patients are getting both antibiotics and coumadin, they are at increased risk of gastrointestinal bleeding or bleeding in the stomach. One of the signs of this is so-called “coffee-grounds emesis” which is essentially blood-tinged vomit. This is an emergency situation and 911 should be called.
On the morning of June 2, paramedics were called to the nursing home for vomiting. The crew was informed that the resident had 4-5 episodes of coffee ground emesis the night before. The resident then vomited in front of the ambulance crew, this time vomiting bright red blood. He lost a pulse, and CPR was initiated, but the resident died that day. One cause of death on the death certificate was gastrointestinal bleeding.
This case presents a fairly simple instance of the nursing staff failing to recognize that a resident was experiencing a medical expergency and failing to take appropriate steps in response. Coffee grounds emesis is a sign of something serious, and even if the nursing staff did not recognize the full implications of a resident having that, a doctor would have. Either way — calling a doctor or calling 911 — this resident would have been sent to the hospital where there would be a real chance of avoiding this tragic outcome.
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