cms_WV: 9636
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9636 | BRIGHTWOOD CENTER | 515128 | 840 LEE ROAD | FOLLANSBEE | WV | 26037 | 2009-12-17 | 155 | D | 0 | 1 | 6HX711 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, Hospice staff interview, and observation, the facility failed, for one (1) of eighteen (18) residents sampled, to allow refusal of treatment. The resident, who was also under the care of Hospice services, had requested through her medical power of attorney representative (MPOA) via the Physician order [REDACTED]. IV fluids had continued for a period of at least twenty-nine (29) days following the resident's hospitalization and return to the facility, with no evidence the facility recognized the right to refuse them and/or worked in conjunction with her physician and the Hospice agency to discontinue the IV fluids. Resident identifier: #13. Facility census: 105. Findings include: a) Resident #13 The medical record of Resident #13, when reviewed on 12/15/09, disclosed this [AGE] year old female had resided at the facility since 12/22/04. Her medical [DIAGNOSES REDACTED]. She had returned to the facility from her most recent hospitalization on [DATE], having been admitted to the hospital with [REDACTED]. On 12/08/09, the resident's attending physician wrote an order for [REDACTED]. The resident's medical record, when further reviewed, revealed she did not have the capacity to make her own medical decisions, as determined by her attending physician on 09/02/08. The most recent minimum data set (MDS), with an assessment reference date of 11/26/09, in the area of Cognitive / Decisionmaking described this resident as 3, severely impaired, rarely / never made decisions. The record disclosed a POST form which stated, This is a physician's orders [REDACTED]. Any section not completed indicates full treatment for [REDACTED]. All areas of the POST form were completed on 12/10/08, with the resident's MPOA signature noted in Section F. The document was reviewed on 11/30/09 with no changes noted. The form requested under Section A - Do Not Attempt Resuscitation; under Section B - Comfort Measures; under Section C - Antibiotics; and under Section D - IV fluids for a defined trial period. In Section E, it was noted these were discussed with MPOA, and under The Basis for These Orders Is was marked Patient's best interests (patient preferences unknown). The resident's medical record did not contain a Living Will document. Observation, during a wound care treatment on the afternoon of 12/15/09, found the resident was receiving an infusion of IV fluids. The infusion was [MEDICATION NAME], and it was infusing at forty (40) cc/per hour. [MEDICATION NAME], according to RxList Inc., the Internet Drug List at www.rxlist.com, is a sterile, nonpyrogenic, moderately hypertonic intravenous injection containing [MEDICATION NAME], a nonprotein energy substrate and maintenance electrolytes. [MEDICATION NAME] is indicated for peripheral administration in adults to preserve body protein and improve nitrogen balance in well-nourished, mildly catabolic patients who require short-term [MEDICATION NAME] nutrition. The source of the implementation of the IV fluids was found to be a physician's orders [REDACTED]. The resident was non-responsive during the wound care, even when turned from side to side by staff. When questioned as to the palliative purpose of the infusing fluids, the nurse completing treatment (Employee #113) stated she wasn't sure. When asked if the fluids had prevented a further decline in the resident's condition, the nurse stated, No. The facility's director of nurses (DON - Employee #99, when interviewed related to this observation on 12/15/09 at approximately 3:00 p.m., stated she did not know if the resident's MPOA had been contacted related to the continuation of the IV fluids at the time of re-admission from the hospital or at the time of the admission to Hospice Services. She did recall there had been discussion about the IV fluids among staff. Return to the medical record divulged a social services note, dated 11/30/09, stating, POST form discussed with Daughter / MPOA on 11/30/09 (sic) with no changes. This note also stated the resident has been exhibiting behaviors of refusing / spitting out meals and medications. The social worker (Employee #140), when interviewed on the morning of 12/16/09, was asked if she was aware the resident's current care was in contradiction with the POST form with respect to the continued administration of IV fluid infusion. The social worker stated that, during the care plan meeting for this resident on 12/08/09, when the resident's MPOA and Hospice nurse were present, Hospice staff had indicated they would address this situation. She made no mention of the issue being addressed at the time of the resident's re-admission to the facility on [DATE], or at the time of the documented Review of the POS [REDACTED] On 12/16/09 at 9:30 a.m., a Hospice nurse (Employee #142) was visiting the resident in her room. This nurse was questioned as to if Hospice staff had attempted to contact the resident's MPOA about the continued infusion of IV fluids, in light of her noted desires on the resident's POST form. It had now been eight (8) days since Hospice had become involved in the resident's care. The Hospice nurse stated he thought someone had tried to contact the MPOA with no success and that he had just met the resident for the first time. He further stated the physician had been contacted by facility staff the previous evening (on 12/15/09), following questioning by this surveyor, and he wanted the IV fluids to continue. The Hospice nurse could give no reason for the continued use of IV fluids and could not describe any palliative purpose the IV fluids may be serving. The Hospice nurse also stated that discontinuing the fluids was the decision of the resident's attending physician. When asked if the Hospice medical director might not intervene in a situation similar to this, the Hospice nurse responded, No. The Hospice nurse then described the resident's attending physician as sometimes being hesitant to act upon recommendations by Hospice staff. Later on this same day at approximately 2:00 p.m., the Hospice nurse informed this surveyor that the resident's MPOA had been contacted and her desire was to discontinue the IV fluid infusion. He stated a request for that order had been communicated to the attending physician. According to Hospice Philosophy, as noted by the Hospice Patient's Alliance and found at www.hospicepatients.org/hospic28.html, When appetite declines and your loved one is refusing food, it's quite difficult to accept. We all know that you have to eat to live, but what many of us don't know is that if your body can't process the food because of a terminal illness, forcing nutrition in will not prolong life. There is a natural process in the dying: decreased appetite, decreased thirst, gradual withdrawal from the concerns of this world and focus on concerns about death and taking care of 'unfinished business' with family. The refusal of food / nutrition, according to Hospice Philosophy, is a normal part of the dying process. At the time of the resident's admission to Hospice, the resident's MPOA, with the resident's best interest in mind, agreed to accept the Hospice philosophy. Review of the documents on the resident's medical record that had been provided to the MPOA at the time of admission disclosed a document entitled Section C: Bill of Rights. This document stated, Consistent with state laws, the patient's family or guardian may exercise the patient's rights when the patient is unable to do so. Hospice organizations have an obligation to protect and promote the rights of their patients. There was no evidence, through record review or staff interview, that the facility had made efforts to coordinate with the resident's MPOA, the Hospice Agency, and the resident's attending physician to effectively honor the desire for IV fluids only for defined trial period. There was no documentation of a plan to discontinue the IV fluids, a defined time period for their use was not designated, and there was no documented purpose for their use in providing palliative / comfort care to the resident. At the time of exit from the facility at 10:00 a.m. on 12/17/09, the IV fluids continued to infuse for this resident. | 2015-10-01 |