The Grove at the Lake nursing home in Zion was cited and fined by IDPH after a resident choked on a hot dog.
The resident at issue had a diagnosis of dysphagia, or difficulty with swallowing, and a history of choking. This diagnosis and the history of choking demonstrated that she was at risk for choking. With a recognized risk of choking, the nursing home actually did the appropriate thing: they developed a care plan which addressed the resident’s risk of choking. The care plan included observing the resident while eating for signs and symptoms of choking.
On the night of the choking accident, the nurses on duty were at the nurses station while the residents were being fed dinner. A CNA brought the resident to the nurse’s station and said that the resident was having difficulty breathing. The nurse recognized right away that the resident was not breathing and took her to her room to begin resuscitation efforts. She did a finger sweep of the mouth which pulled out meat and began CPR. 911 was called and she was brought to the hospital, where she survived but was required to undergo a tracheostomy and placement of a feeding tube.
When IDPH came to interview the staff on duty, no one admitted to being the aide who brought the resident to the nurse’s station. All of the aides further denied knowing that the resident was a choking risk.
When a resident is recognized as being at risk for choking based on their medical diagnosis and a demonstrated history of choking, care planning to address that risk is the right thing to do. However, in this case, the Grove fell short in two respects:
- The care plan itself was inadequate. While placing general responsibility to observe for choking is a start, the high risk that a choking accident will result in the wrongful death of the nursing home resident called for placement of the resident at a feeder table where there is a specific aide responsible for assisting residents in need of help with eating. Having this intervention in place allows the resident to get help immediately when a choking incident starts.
- The care plan was not communicated to the staff charged with providing the care. There were a number of aides in the dining room at the time of the choking accident, but none of them knew that the resident was at risk for choking. If they didn’t know that, there was no special need for them to be paying attention to this resident choking. Communicating the contents of the care plan to direct care staff is a basic part of the care planning process.
This choking accident was a highly preventable accident. A better care plan effectively communicated to the staff would have either avoided this accident all together or at least kept the consequences of the choking incident from being so grim. It is a classic example of why effective care planning is an essential tool for providing good care in nursing homes – and why it is so effective for prosecuting nursing home abuse and neglect cases.
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