cms_AK: 99
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 99 | PROVIDENCE TRANSITIONAL CARE CENTER | 25018 | 910 COMPASSION CIRCLE | ANCHORAGE | AK | 99504 | 2018-07-13 | 726 | E | 0 | 1 | FK4811 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure staff had appropriate competencies and skills necessary to care for include the clinical needs of 2 residents #s (16 and 24) with pacemakers and 1 resident (#39) bi-ventricular implantable cardiac defibrillator (BI-V ICD- a special type of pacemaker with a defibrillator used to resynchronize the heart muscle in heart failure patients) in the facility, out of 3 sampled residents with implanted devices. This failed practice placed the residents at risk for undiagnosed heart rhythm irregularities, missed necessary cardiac monitoring, equipment, care and decreased heart health. Findings: Resident #16 Record review from 7/9-13/18 revealed Resident #16 was admitted to the facility with a [DIAGNOSES REDACTED]. Review of Resident #16's care plan, last updated 5/9/17, revealed no documentation of the presence of a pacemaker or any type of cardiac device monitoring. Review of Resident #16's Resident Daily Care Plan (RDCP), dated 5/15/18, revealed no documentation of a cardiac pacemaker. Random observations from 7/9-13/18 revealed no telephonic equipment for cardiac pacemaker monitoring for the Resident. Resident #24 Record review from 7/9-13/18 revealed Resident #24 was admitted to the facility with [DIAGNOSES REDACTED]. Review of Resident #24's care plan, last updated 6/6/18, revealed no documentation regarding any type of pacemaker monitoring. During an interview on 7/12/18 at 10:10 am, with Resident #24's son and daughter, Resident's #24's son stated that he had no interaction with the staff regarding Resident #24's pacemaker. Random observations of the resident's room from 7/9-13/18 revealed no telephonic equipment, used for cardiac pacemaker monitoring, present for the Resident. Resident #39 Record review from 7/9-13/18 revealed Resident #39 was admitted to the facility with a [DIAGNOSES REDACTED]. During an interview on 7/9/18 at 9:17 am, Resident #39 stated that they had a BI-V ICD for several years. Record review of Resident #39's care plan, last updated 6/13/18, revealed no documentation of a plan to monitor Resident's pacemaker/ICD. Review of Resident #39's Resident Daily Care Plan (RDCP), dated 6/1/18, revealed no documentation of a cardiac pacemaker/ICD. Random observations of the resident's room from 7/9-13/18 revealed no telephonic equipment, for cardiac pacemaker/ICD monitoring, present for the Resident. During an interview on 7/11/18 at 2:35 pm, Licensed Nurse (LN) #1 and LN #2 stated they did not know of telemetry boxes or need of monitoring equipment for pacemakers. During an interview with the Alaska Heart & Vascular Institute Electrophysiology Clinic Manager (AH&VI EP Manager), when asked how often cardiac devices are monitored, he/she stated that telephonic transmittals should be done every 3 months. During an interview on 7/12/18 at 4:03 pm, the Director of Nursing (DON) stated the Nurse Educator was to ask where the resident is being seen for his/her pacemaker care. The DON also stated if residents have a device at home to check the pacemaker they bring them in so it can be done at the facility. The family or resident tells staff they have a pacemaker check coming up and the residents are sent out for the check. In addition, the DON stated she is not sure what happens after the pacemaker is put on the [DIAGNOSES REDACTED]. When asked for a policy on pacemakers, surveyors were told the facility did not have one. A pacemaker protocol was then requested. The protocol was not provided by survey exit. | 2020-09-01 |