IDPH has cited and fined Alden of Waterford when the facility failed to recognize the severity of a critically low potassium level. In place of calling 911, a RN called the local ambulance service, which took nearly two hours to arrive, only to find the resident in cardiac arrest, requiring CPR, and subsequently passing away at the hospital.
The resident’s progress notes written by an RN state that the lab called the nursing home facility and spoke with the RN about the low potassium level (of 2.4mmol (millimoles)/L (liter)). The RN paged the resident’s Primary Physician and spoke with a Nurse Practitioner. The NP advised that the RN send the resident to the ER. The notes further mention that the local private ambulance was called around 5:15 PM, and they stated an estimated pickup time of 1-2 hours later. Upon the ambulance’s arrival at approximately 7:13 PM (nearly 2 hours later), the resident was found unresponsive, and compressions were started. 911 was called at 7:15 PM, and paramedics arrived at the scene at 7:22 PM, transporting the resident to the ER at 7:34 PM. Later that evening the ER nurse informed the facility that the resident had expired in the ER.
The critical error in this case was the failure to immediately call 911 when the RN was informed that it would take 1-2 hours for the local ambulance service to arrive on site. The RN claimed that the resident’s vital signs were stable, and that when the lab called regarding the low potassium level “it did not seem urgent.” The RN mentioned that “the resident had a poor appetite but that even his oxygen level was ok.” Further, “If the potassium was low then it would cause heart issues. I would think there would be a change in his vital signs. There was no change since the AM. I had him all day.”
The Nurse Practitioner at the Primary Physician’s office stated “they were to send him to the ER. They should have called 911. With a potassium that low that would have been urgent. They never called me back to say that it was going to be 1-2 hours.”
The Director of Nursing, also expressed that waiting 1-2 hours for an ambulance was unacceptable and that with a critically low potassium level, they should have called 911.
The facility’s failure to follow their change of condition policy, assess the resident properly, and call 911 (in place of the local ambulance service) resulted in a delay in receiving a higher level of care and ultimately contributed to the resident’s death.
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