IDPH has cited and fined the Grove of Evanston nursing home following the death of a resident there after the staff failed to notify the resident’s doctor of declines in the resident’s condition over a period of several days.
One of the many ways that a nursing home is not the same as a hospital is that there is not a doctor on hand 24/7 the same way there usually is in hospitals in larger communities. Because the doctor is usually not present in the nursing home, one of the key roles that nurses in a nursing home setting play is to serve as the “eyes and ears” of the doctor. This means that the nursing staff has an obligation to notify the doctor of changes in the resident’s condition. The nurse doesn’t have to diagnose the condition or problem – she must simply notify the doctor of what has happened or is happening with the resident so that the doctor can make a determination whether to come into the nursing home, issue orders over the phone for treatment, or order the resident sent to the hospital. When the staff fails to notify the doctor when the situation calls for it, the failure to obtain needed care and treatment can have significant consequences in a medically fragile patient population, including resulting in the wrongful death of the nursing home resident.
The citation in the is instance reflected that the staff was aware that the resident’s condition was declining over a period of days. Rather than notify the doctor, the assistant director of nursing asked therapy to evaluate the resident. Over a period of four days, the resident’s condition continued to decline, until it declined so much that the staff called 911. When they did so, the resident’s oxygen saturations were at 87 with 10 liters of supplemental oxygen and a heart rate of 51. When the resident was brought to the emergency room, lab work showed that the resident had highly elevated white blood cell counts, lactate levels, and potassium levels. In short, this resident was critically ill. He was intubated and given three separate antibiotics, but died shortly after midnight, less than 18 hours after being sent to the hospital.
This is a case where the nursing staff failed to make the required notifications to resident’s doctor. Clearly, they recognized that something was amiss, as there were plans to have therapy evaluate the resident, but it is also clear from the citation that the resident’s chart drew a picture of ongoing declines in the resident’s condition. Without timely notification of the resident’s doctor, this resident was denied the opportunity to receive treatment which could have altered the course of the resident’s illness. This represented a basic failure to deliver the care that the resident needed and deserved.
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