IDPH has cited and fined Mattoon Rehabilitation & Health Care Center nursing home after a resident there had to be sent to the hospital suffering from encephalopathy and acute kidney injury due to dehydration.
One of the basic commitments that nursing homes make when they accept a resident for admission is that they will do what is required to help maintain the resident’s basic health. Many people are therefore shocked to hear of nursing home residents suffering from conditions like dehydration and malnutrition.
This resident was admitted for treatment with IV antibiotics, including vancomycin and cephapime, for treatment of osteomyelitis and discitis. Her medical history included congestive heart failure for which she was receiving a diuretic (commonly known as a “water pill”). One of the effects of taking a diuretic is that you urinate frequently (hence the term “water pill”), which can lead to dehydration. Because this is a known risk of use of a diuretic, it is something that should be addressed in the resident care plan.
The care planning process is the road map for providing much of the routine care that resident’s receive in a nursing home. It begins with the resident assessment which identifies the known risks to the health and well-being of the resident. From there, a care plan is developed. This includes a series of steps, or interventions which must be taken on a day-to-day, shift-to-shift basis to minimize the risks to the health and well-being of the resident. Once a care plan is put into place it must be communicated to the staff charged with carrying it out and then actually implemented on a day-to-day, shift-to-shift basis.
When a resident is at risk for dehydration due to the use of a diuretic, this is something that should be addressed in the resident care plan. This would include simple measures such as encouraging fluids, monitoring fluid intake, and monitoring signs and symptoms of dehydration. These would include a dry mouth, diminished urine output, darker colored urine, and increased lethargy and confusion.
Having and executing a care plan to address the risk of dehydration is especially critical in residents who are receiving the antibiotic vancomycin. Vancomycin is known to have adverse effects on the kidneys, made worse when the patient is suffering from dehydration.
When the resident was admitted to the nursing home, she was assessed as having no cognitive issues, was alert and oriented, and able to make her needs known. Over the first few days of her admission to the nursing home, she was not eating much and was only taking a few sips of water.
One the sixth and seventh days after she was admitted to the nursing home, the staff noted that the resident was having disorganized thinking, difficulty with finding words, and slowed response times. The resident chart further recorded that had poor appetite and was tired. These were signs and symptoms of dehydration. The onset of these signs and symptoms represented a change in resident condition which should have prompted physician notification.
On the eighth day after she was admitted, a nurse returned from vacation and cared for this resident for the first time. She was advised by the staff that the resident was able to make her needs known and was alter when she was admitted. The nurse contacted the resident’s physician who ordered labs drawn the next day.
Unfortunately, the evening, the resident experiencing muscle jerking and twitching and was sent to the hospital. Labs drawn there showed elevated BUN and creatine levels – markers of dehydration and diminished kidney function. The resident was diagnosed with acute kidney injury and encephalopathy (brain dysfunction) all related to her dehydration. She had to be admitted to receive fluids – something which is dangerous for a patient suffering from congestive heart failure as this resident was.
Additionally, the resident was discovered to have developed multiple bed sores. When the resident was admitted to the facility, she did not have any skin breakdowns. Federal regulations require that resident receive care, treatment, and services necessary to prevent the development of bed sores. Dehydration is a known risk factor for the development of bed sores. Immobility is another one, something that was likely true for this resident as she became weak and lethargic due to her dehydration.
These issue – the dehydration and all of its complications, as well as the bed sores – are the simple result of routine care not being provided to this resident. 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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