IDPH has cited and fined the Grove of Elmhurst nursing home after a resident there died due to a 30-hours delay in notifying the resident’s physician about a fever exceeding 104 degrees.
One of the basic truisms of care in a nursing home setting is that doctors are not there on a 24/7 basis. Because of this, nurses must be the “eyes and ears” of the doctors and let them know when there has been a change in the condition of a resident. The nurse does not need to know what the change represents (though they often have a good idea) or how to treat it. Those things are the role of the doctor. The nurse simply needs to be able to identify the change in condition, notify the resident’s physician, and give the doctor enough good information about what is happening to allow good decision-making. Once the doctor is informed of the problem, then the doctor must decide to come to the nursing home, issue orders over the phone, or order the resident transferred to the hospital.
The resident at issue had been admitted to the nursing home with a number of medical problem, including: multiple rib fractures, chronic respiratory failure, encephalopathy, a tracheostomy, and anoxic brain damage. He was in a comatose state and dependent on staff for care. At the time of admission, he had been running low-grade fevers (98-101), so the attending doctor requested consultations with an infectious disease physician who assigned a nurse practitioner to the patient.
On the morning of the fourth day after admission, the resident’s temperature rose to 104.5 degree. This represented a change in condition for the resident, and should have triggered notification of the resident’s physician or the infectious disease nurse practitioner. The resident’s temperature was taken 7 times during the course of that day, yielding temperatures of 102 degree or higher 5 times. Neither the resident’s physician or the infectious disease nurse practitioner were notified of the rising temperatures.
The following day, the resident’s temperature was taken at 6:30 a.m. and was 102 degrees, but dropped down to 99.9 at 8:53 a.m. However, it climbed back to 104.5 degree by 10:57. After the temperature climbed back up over 104 degrees, the staff called the doctor but he was not available so they had him paged. No effort was made to reach the infectious disease nurse practitioner.
At 12:55 p.m., the respiratory therapist was treating the resident and noted a heart rate of 120-130 after suctioning. The nurse assessed the resident and found that the resident had a temperature of 101.4 and a heart rate of 118. Fevers and an elevated heart rate are signs of sepsis. The primary care physician was paged again, although no effort was made to reach the infectious disease nurse practitioner.
The attending physician was paged again at 3 pm and this time the doctor was reached. He was informed of the resident’s condition and ordered the resident be sent to the emergency room. The staff first called a private ambulance service and was told that it would be 90 minutes for an ambulance to arrive. The nurse went to assess the resident again and noted shallow breathing. The nurse and the respiratory therapist began to do CPR using an ambu-bag. 911 was called, and the paramedics arrived 8 minutes later. On arrival the resident had no pulse and was in respiratory arrest. They were able to regain a pulse twice in their resuscitative efforts, but the resident died less than an hour after the paramedics arrived. The apparent cause of death was pneumonia – a condition which could have been better addressed in a hospital setting.
There were a number of shortcomings in the care that this resident received:
- When the resident initially developed temperatures in excess of 104 degrees, no one was notified of the development of that high a fever. It represented a change in condition and a real threat to the health and well-being of the resident.
- There was no effort to notify the infectious disease nurse practitioner. The fever and rapid heart rate were signs of sepsis and seeing as this specialist was brought in to help manage this aspect of the resident’s care, notifying the nurse practitioner was a reasonable option when the 104 degree fever developed and/or the attending could not be reached.
- There was inadequate follow up when the attending physician could not be reached. Once a doctor is paged and is not responding, additional follow-up efforts are required to actually reach the doctor to get his guidance.
- Finally, when a doctor cannot be reached, the facility medical director should be contacted to obtain orders if necessary. It is simply not acceptable to not get some medical direction when the resident’s situation calls for it.
The net result of all of this is that there was a 30 hour delay in getting the instructions that were required when the resident first developed the 104 degree fever. This was a medically complex, medically fragile individual for whom timely care was required. When a resident suffers from an infection like pneumonia, delays in receiving care can contribute to the development of complications like sepsis which can in turn feed other complications.
One of our basic 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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