**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined the facility failed to assess, monitor and intervene for one (#1) of three sampled residents who experienced a change in status and required transfer to a medical facility. The facility failed to obtain emergency care for resident #1 who complained of chest pain and had a respiratory rate of 40 for at least 1 to 1 1/4 hours before an ambulance was called for transport to a hospital. The resident was diagnosed with [REDACTED]. Sixty-one residents resided in the facility.

On 01/16/18 at 10:19 a.m., the director of nurses (DON) was asked if LPN #1 had kept her informed about resident #1’s condition throughout the day on 01/02/18. She stated, Yes. She stated LPN #1 had reported to her about 1:30 p.m. that the resident’s family was concerned, the physician was called and orders were given. The DON was asked if LPN #1 had informed her the resident had complained of chest pain and was using accessory muscles to breathe. She stated, No. She never said that or that accessory muscles were used. She stated LPN #1 had reported to her that resident #1’s family were concerned.

The DON was asked if she had assessed the resident at any time during the day on 01/02/18. She stated, No. She was asked if a physician’s orders [REDACTED]. She stated, Nursing judgement can be used but we do need a physician’s orders [REDACTED].>The DON was asked if 1 1/2 hours was a good response time to seek medical attention for a resident with a respiratory rate of 40 and complaints of chest pain. She stated, I don’t think it was 1 1/2 hours. I think (RN #1) would have assessed her about 3:30 – 3:35, called the doctor, reviewed the chart and discussed the situation with the family.

The DON was asked if 1 1/4 hours was an appropriate length of time to send a resident out with chest pain and a respiratory rate of 40. She stated, Under normal circumstances, no. But (RN #1) didn’t know the resident and had to review her (medications), take (vital signs) and assess her.

The DON was asked if she became involved in the care of the resident at any point. She stated, Yes. At 4:30 – 4:45, RN #1 had consulted her and informed her of the resident’s respiratory rate, right side chest pain and that she had been unable to speak to the physician. The DON stated she told RN #1 to go ahead and call an ambulance for resident #1. The DON was asked if anyone had considered calling the facility’s medical director when the resident’s physician did not respond to a phone call. She stated, I’m not sure if they did or not. She was asked if chest pain required medical intervention. She stated, Yes.

The resident’s physician was asked if she believed a resident with chest pain and a respiratory rate of 40 constituted an emergency situation. She stated, Yes. She was asked if she thought 1 to 1 1/4 hours was a long time to wait to call an ambulance for a resident with chest pain and a respiratory rate of 40. She stated she thought 15 minutes would have been long enough to wait for her to return the call to the facility before they went ahead and called the ambulance when the resident had the symptoms she had.