IDPH has cited and fined Greentree of Bradley nursing home after a resident was hospitalized with a gastronintestimal bleed caused by the failure of the nursing home staff to monitor the resident’s levels of anticoagulant medication.
Blood thinning medications, or anticoagulants, are an important tool in the doctor’s toolbox for maintaining the health of nursing home residents. Nursing home residents who are at risk for developing blood clots are generally given these medications to reduce the risk of things like stroke, deep venous thrombosis, pulmonary embolism, and other serious medical issues.
To determine whether the resident is receiving the right level of anticoagulant, doctors rely on a lab test called a PTT/INR. When the lab shows a score which is too low, that is called subtherapeutic which means that there is an increased risk of developing blood clots. When the score is too high, that means that the blood, that means that there is an increased risk of uncontrolled bleeding. Depending whether the score is too high or too low, the doctor can adjust the order to get the PTT/INR in the desired range. For that to happen, the labs must be done and the doctor notified of any abnormal lab results.
That is where things went wrong in this case.
The resident at issue was admitted to the nursing home with orders to receive warfarin (coumadin) 5.0 mg per day for atrial fibrillation (an irregular heartbeat which can produce blood clots which cause strokes) and left leg deep venous thrombosis (blood clotting which can cause pulmonary emboli, which are almost always fatal). The labs when discharged from the hospital showed a PTT/INR level of 3.0 with a target level of 2.0 – 3.0.
After being admitted to the nursing home, no labs were obtained. The resident continued to receive the ordered warfarin with no lab work being done to check whether the levels were appropriate. Approximately one month after being admitted, the staff discovered large anounts of blood on the bed linens with large clots. The resident was sent to the hospital at a PTT/INR score over 11. This is referred to as being supratherapeutic and is associated with a risk on uncontrolled bleeding. The resident was admitted to the intensive care unit with uncontrolled bleeding.
At this facility, the doctor had standing orders regarding the lab work and there were policies in place regarding doing lab work on all residents admitted with an order for anticoagulants. This lab work was never done, and as a result, the resident’s anticoagulant levels climbed dangerously high, resulting in the gastrointestinal bleed and the transfer to the intensive care unit.
Simple steps not taken, leading to disastrous results.
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