| 91 |
MALUHIA |
125009 |
1027 HALA DRIVE |
HONOLULU |
HI |
96817 |
2019-07-12 |
695 |
D |
0 |
1 |
55H911 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure that a resident who needs respiratory care, including [MEDICAL CONDITION] care and tracheal suctioning, is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan and the residents' goals and preferences for one of one residents (Resident (R) 20) selected for review. This deficient practice had the potential to affect the other residents identified by the facility to require [MEDICAL CONDITION] care. Findings Include: On 07/09/19 at 03:33 PM, a random observation of Resident (R) 20 was done. R20 has a [MEDICAL CONDITION] and a care plan for being at risk for respiratory difficulty related to his [MEDICAL CONDITION] (trach) site. R20's care plan states he also requires frequent suctioning 4-6x (times) per day, including suctioning to [MEDICAL CONDITION] as needed for excessive oral secretions, and to assess his respiratory status (i.e., increased respiratory rate). During this observation, R20 exhibited an increased respiratory rate, intermittent gurgling like sounds and had whitish secretions coming out from [MEDICAL CONDITION] onto a napkin placed around [MEDICAL CONDITION]. At that time, the certified nurse aide (CNA) 1 who had taken R20's vital signs was in the hallway along with registered nurse (RN) 3. CNA1 stated she reported R20's status to the on-coming evening shift nurse, RN1, about five minutes prior. CNA1 said she told RN1 that R20 needed to be suctioned and had an increased respiratory rate around like 30 (breaths per minute). RN3 then stated the nursing endorsement can wait at the change of shift and went to find RN1. On 07/09/19 at 03:37 PM, RN1 came to attend to R20 at bedside. She prepped using sterile technique, but had some difficulty donning the gloves since she opened the sterile glove set on the resident's bed, along with [MEDICAL CONDITION]. There was an overbed table to use, but she did not use it. At 03:42 PM, she began the tracheal suctioning of the resident and suctioned R20 three times. Afterward, RN1 removed a napkin that had been placed around [MEDICAL CONDITION]. Upon removal, the front part of R20's clothing was wet from the secretions. RN1 said she was going to ask the CNA to change him. She also said, I'm gonna change this one too, (the [MEDICAL CONDITION] under the ties) and stepped out to get some saline. Upon her return, she cut a small hole in the middle of a new napkin and placed it over [MEDICAL CONDITION]. It was observed RN1 did this to replace the soiled one. On 07/09/19 at 03:49 PM, RN1 said that CNA1 told her that R20 needed to be suctioned but did not mention any urgency. RN1 stated she had been, counting and getting report from the day shift nurse. She affirmed however, she heard from the endorsement report that R20 needed to be suctioned more frequently than usual. At 04:03 PM, RN1 said she was going to suction R20 again. In the same manner as the first set up, she placed her sterile glove [MEDICAL CONDITION] again on R20's bed. At 04:06 PM, RN1 began the second round of tracheal suctioning, which she did twice. After this, she confirmed it was not until RN3 informed her about R20 that she dropped everything to do this. RN1 said, If she (CNA1) would tell me he really needed then I would have come. It wasn't mentioned that he was gurgly. On 07/09/19 at 04:14 PM, per a re-interview of CNA1, she re-verified she mentioned to RN1 that R20 needed to be suctioned and his breathing rate was higher when RN1 was getting report. On 07/09/19 at 04:37 PM, during an interview with the unit's head nurse, RN2, she said RN1 was a per diem nurse. Then during a concurrent observation at R20's bedside with RN2, she saw [MEDICAL CONDITION] and said, should always be visible and open and removed the napkin which RN1 had placed over it through the cut out opening to replace the soiled one. On 07/09/19, at approximately 5:10 PM, during an interview with RN3, she said, We have some young nurses, but the nurse has to go to the resident and assess and you can ask someone else to cover what you're doing. I'll be talking to them. On 07/11/19 at 09:09 AM during an concurent record review and interview with RN2, it was found that RN1 had no documentation related to her care provided to R20 on the evening shift of 07/09/19. There was no nursing assessment, no interventions/care provided, nor a follow-up note on R20's respiratory status. R20 had been suctioned five times, had increased secretions and an increased respiratory rate. Further, RN2 verified the only entry was a 07/09/19 15:30 (3:30 PM) entry showing R20's respiratory rate was documented at 30 breaths/minute with a warning High of 28.0 exceeded. When RN2 was asked about the expectations/standard of care for documentation by licensed staff, RN2 said she spoke to her staff about communication and the need to respond. She also said that nursing staff were no longer to place napkins over [MEDICAL CONDITION]. RN2 said R20 recently finished a course of antibiotics for seven days for pneumonia, and acknowledged there was a lack of documentation by RN1 regarding R20's condition and status. On 07/11/19 01:10 PM, during a concurrent review with RN2 regarding the job description (JD) for RN1 as a per diem nurse, it stated under major duties and responsibilities, [NAME] Nursing Care: . 3. Assesses resident's condition (physical and psychological); prioritizes needs; . 5. Reports and records pertinent observations and reactions to care rendered. B. Patient care activities, 2. b. Assess and reflects condition of resident accurately. d. Documents assessments. On 07/12/19 at 10:24 AM, RN2 said if there was anything out of baseline, the licensed staff, need to do a progress note. Even if they did do the suctioning, (only that documentation) looks like just a routine event versus something else going on at that time. She said for RN1 as a per diem nurse, she worked on the unit about once or twice a month, but affirmed there should have been some documentation by RN1 about her assessments and provision of care provided to R20 on 07/09/19. This failure to document was an indication of the lack of competency using standard nursing practices, for a resident who requires and is dependent on staff to provide airway management and on-going care. |
2020-09-01 |