KINDRED TRANSITIONAL CARE AND REHAB-EAGLE CREEK
LOCATED: 4102 SHORE DRIVE, INDIANAPOLIS, IN 46254
KINDRED TRANSITIONAL CARE AND REHAB-EAGLE CREEK was cited by the DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES for the following deficiencies:
PLEASE NOTE: The following highlighted quoted text is only a portion of the full report/survey submitted by DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES. The full report/survey can be found here.
FACILITY FAILED TO PROVIDE NECESSARY CARE AND SERVICES TO MAINTAIN THE HIGHEST WELL BEING OF EACH RESIDENT
LEVEL OF HARM – ACTUAL HARM
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on record review and interview, the facility failed to assess and monitor bowel sounds/elimination patterns and failed to implement interventions in the bowel protocol resulting in hospitalization , fecal impaction, and surgery to remove the large intestine for 1 of 7 residents reviewed for quality of care (Resident C).
The record indicated Resident C did not have a bowel movement on [DATE], 17, 18, 19, or 20, 2014. A nurse’s note, dated [DATE] at 4:36 p.m., indicated, .Situation: c/o (complaint of) cramping lower abd (abdomen) pain-poor appetite continues pt (patient) reports having this pain at times, but increased yesterday evening. Condition has gotten worse.
A nurse’s note, dated [DATE] at 5:45 p.m., indicated resident did not have bowel elimination after the [MEDICATION NAME] suppository. A nurse’s note dated [DATE] at 8:15 p.m., indicated Resident C had small amount of liquid emesis-yellow in color. The record lacked indication a physician was notified of Resident C’s emesis or additional assessments of her bowel sounds and/or abdominal palpation for distention/firmness/pain throughout the night. A physician’s telephone order, dated [DATE] at 8:00 a.m., indicated a stat (immediate) KUB (X-ray) of the abdomen due to abdominal pain and no bowel sounds. The order indicated bowel sounds were to be monitored every shift for 48 hours. A nurse’s note, dated [DATE] at 5:00 p.m., indicated Resident C required much encouragement to drink sips of water, had no appetite, and was very confused and lethargic. The record indicated the Nurse Practitioner was notified and ordered intravenous fluids. The record lacked indication bowel sounds were assessed or abdomen was palpated for distention, firmness or pain. A nurse’s note, dated [DATE] at 6:06 p.m., indicated, .confusion continues-will answer questions appropriately at times. And (sic) Abdomen slightly distended and soft. BS (bowel sounds) remain hypoactive (reduced loudness, tone, and regularity of bowel sounds)-has had smears of liquid stool. A nurse’s note dated [DATE] at 8:35 p.m., indicated Resident C complained of abdominal pain, spat out her pain medications when administered, and only took sips of water and Boost with much encouragement. The record lacked indication bowel sounds and/or abdominal assessment was completed. The record lacked indication Resident C’s bowel sounds were assessed during the night shift on [DATE]. A nurse’s note dated [DATE] at 3:30 a.m., indicated, In bed. Lethargic. Non responsive to verbal commands. Restless. Raising et (and) lowering right arm. BUE (bilateral upper extremities cool to touch. Continues IV (intravenous) therapy. Hr (heart rate) 135 fluctuating 117. Husband called informed of condition change. Husband stated he would like for her to be sent to the ER. ambulance here to transport at 4:10 a.m. A hospital record, dated [DATE] at 5:59 a.m., titled Imaging Exam Report reviewed, on [DATE] at 2:30 p.m., indicated a cat scan of the abdomen was obtained due to Resident C’s elevated temperature, abnormal white blood count, and abdominal pain. The results indicated,. There is a large stool burden throughout the colon. Beginning at the level of splenic flexure and extending inferiorly. Large stool burden throughout the colon, greatest in the descendingcolon and sigmoid. Correlate for fecal impaction. A hospital document, dated [DATE], titled Case Manager Progress Note indicated Resident C was admitted to an acute hospital on [DATE] with [DIAGNOSES REDACTED]. This note further indicated she was transferred to another acute hospital for an operation for emergent bowel resection. An operative note, dated [DATE], indicated Resident C .was brought to the emergency (hospital named) with abdominal pain, nausea, vomiting, and lethargy.CT (Cat Scan) abdomen and pelvis was obtained and found to have [MEDICAL CONDITION] with constipation. Due to her medical condition, the patient was transferred to (hospital named). This note indicated a surgical procedure of total colectomy (removal of the large intestine) with a wound VAC placement was performed with a post operative [DIAGNOSES REDACTED]. A document, dated [DATE] at 12:34 p.m., titled Imaging Exam Report indicated Resident C required another cat scan of her abdomen due to an increased fever and heart rate post surgery following a total colectomy. A hospital discharge summary, dated [DATE], indicated, .the patient required multiple returns to the operating room, the last of which was done emergently to address what appeared to be a small bowel perforation. This note indicated Resident C progressively declined after this surgery and died on [DATE] at 4:25 p.m. This document indicated cause of death septic and [MEDICATION NAME] shock, multiorgan failure, severe [MEDICAL CONDITION], and post operative complications. During an interview on [DATE] at 12:15 p.m., the Assistant Director of Nursing indicated she expected staff to follow bowel protocols according to residents’ individualized needs. During an interview on [DATE] at 12:30 p.m., the Director of Nursing indicated she was unable to find documentation the order, dated [DATE], for 30 Millimeters of Milk of Magnesia (laxative) was administered as needed for constipation as ordered. She indicated she was unable to find documentation which indicated bowel sound were monitored during the evening shift on [DATE] or [DATE] prior to Resident C’s transfer to the emergency room . She indicated she was unable to find documentation which indicated Resident C’s bowel movements were monitored in [DATE]. She further indicated she was unable to find documentation which indicated the facility’s bowel elimination protocol was followed forResident C.
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