A nursing home in northwest Iowa will pay $6,500 in fines for failing to clear a resident’s airways as he fatally suffocated. The 87-year-old resident had a tracheostomy that needed to be cleared frequently. His plan of care stated that he was unable to care for his tracheostomy, and the interventions included staff performing tracheostomy care every shift and suctioning as necessary. The physician order instructed staff to irrigate/suction with 1 cc sterile saline every 8 hours as needed for phlegm. A suction machine was in his room and the procedure for suctioning was at the nurses’ station.
According to interviews with staff in the state inspection report, the resident was able to communicate to staff that he needed to be suctioned by pointing/patting his stoma. He consistently had thick phlegm which caused him difficulty with breathing. A certified nursing assistant (CNA) said that the resident’s thick phlegm caused unproductive coughing which would scare him, and when that happened she would have to get a nurse right away so he could be suctioned. A second CNA confirmed that the resident was very good about letting staff know when he needed to be suctioned.
On February 27, 2023, two CNAs went into the resident’s room as they did rounds. The resident was visibly soiled, and as they provided care, he pointed at his stoma and patted it, indicating that it needed to be suctioned. One of the CNAs went out to get the nurse to tell her that the resident needed to be suctioned. While she was gone, the resident became very pale and was gasping for air. The second CNA went out to get the nurse to ask her to please come and suction the resident. The nurse went into the resident’s room, said she needed to do an assessment, and left again. When the nurse returned, she took the resident’s blood pressure and pulse and attempted to take his O2 stats. The resident then turned from pale to purple, and then blue.
The nurse said she had to go back to the nurses’ station to see if the resident was a full code or DNR. By the time she got back to the room, the resident had no blood pressure, pulse, or respirations, and was declared deceased.
Compliance Perspective
Issue
Facilities must ensure that residents who need respiratory care, including tracheostomy care and tracheal suctioning, are provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents’ goals and preferences. Suctioning is to be performed by appropriately trained professionals who have previously demonstrated competence.
Discussion Points
- In collaboration with the medical director, director of nursing, and respiratory therapist, ensure that policies and procedures for respiratory care and related services are developed according to professional standards of practice prior to admission of a resident requiring these services. Ensure they require provision of services by qualified personnel as designed by your state’s practice acts. Update policies as needed.
- Prior to the admission of a resident with a tracheostomy, train all appropriate staff on your policies and procedures for tracheostomy care, suctioning, and responding in a timely manner to a resident’s respiratory needs, especially in the event that a resident exhibits respiratory distress. Conduct new hire and annual competencies for appropriate personnel for the use of all resident equipment, to include suction equipment with related items and care of a tracheostomy. When new equipment is purchased, provide training to all staff who are expected to use it, and ensure an updated policy and procedure is available for their reference. Document that the trainings occurred and keep a signed copy in each employee’s education file.
- Periodically audit to ensure that appropriate staff know how to provide tracheostomy care and perform suctioning. Make sure that needed equipment is in a resident’s rooms with all related items in advance of admission of a resident needing this care. Determine through review of staffing schedules that there are always qualified staff on duty who can perform suctioning if needed by a resident. If not already in place, develop a schedule for routine equipment testing to ensure all devices, including suction machines, are periodically tested and in working order should they need to be placed in use immediately.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
