Dehydration occurs when the body does not have enough fluids because more fluid is lost than is taken in.
With the elderly, dehydration can be caused by many factors, but studies indicate that inadequate staffing and lack of supervision are principal causes of dehydration in nursing homes.
In the following case, a nursing home resident’s death was determined to be caused by dehydration coupled with a new or existing cardiac condition that was exacerbated by her dehydration.
What led up to the patient’s death?
One day, a female resident of a nursing home was transferred to a hospital psychiatric ED due to “combative behavior and a possible altered mental state.” She also was lethargic and physically unstable.
The ED staff, who observed the patient for several hours and did lab work, decided she was medically stable but was suffering a psychotic episode. She was returned to the nursing home the following morning.
Upon her return, the patient continued to be lethargic and confused. The RN asked the certified nurse practitioner (CNP) working with her that day to evaluate the patient and asked that the patient be returned to the ED.
The CNP determined that there was no medical reason to transfer the patient back to the ED and told the RN to wait another day. It is important to note that the nursing home’s unwritten policy about transportation fees prohibited nurses from sending residents to the ED.
The patient’s lethargy and mental changes continued throughout the evening. She was administered Lorazepam twice. The following day, the same RN was assigned to care for the patient and was also acting as the nursing home’s facility supervisor. The patient was aggressive, medicated with Ativan several times, did not eat or drink anything, spoke unclearly, and never opened her eyes that day.
The RN checked on the patient around 5:00 p.m. The patient, who was awake and lying on her right side on the floor, told the RN to “leave her alone.” Two student nurse aides (STNAs) noticed the patient’s breathing was labored and thought she should go to the ED.
The RN asked the CNP several times to authorize the patient’s transfer to the ED, but was denied each time. When the RN contacted the facility director of nursing (DON), the DON deferred to the CNP’s decision.
About an hour later, the patient’s son arrived at the nursing home for a visit and found his mother on the floor and not breathing. Someone called 911, but the EMTs couldn’t resuscitate her. She was pronounced dead at the hospital.
An autopsy was requested but wasn’t done. Instead, the medical examiner relied on a review of the patient’s medical records to determine the cause of death. He determined the cause of death was due to an epileptic seizure and hypertensive cardiovascular disease was a contributing factor.
The son filed a lawsuit alleging wrongful death and violations of the state’s nursing home patient bill of rights against the nursing home (and its corporate entities) and the CNP.
The trial court’s decision
The nursing home and the CNP filed a Motion …read more
Read full article here: nurse.com
