Description of Event or Problem · 1
PT WAS AN HMII PT, IMPLANTED ON (B)(6) 2016. SHE HAD BEEN IN AND OUT OF THE HOSP FOR THE PAST SEVERAL MONTHS. MOST RECENTLY, SHE WAS DISCHARGED ON (B)(6) 2018 AFTER A 2 WEEK STAY FOR ELEVATED LDH. SHE WAS DEEMED NOT A PUMP EXCHANGE CANDIDATE DUE TO HER RECENT DRIVELINE INFECTION AND CONTINUED SMOKING. DURING HER ADMISSION, HER LDH REMAINED STABLE AND SHE WAS SENT HOME ON ASPIRIN COUMADIN, PLAVIX AND LOVENOX WITH WEEKLY LAB CHECKS. SHE DID NOT COME IN FOR HER F/U APPT ON (B)(6) 2018, BUT CAME IN THE NEXT DAY. HER LDH WAS FOUND TO BE 1717. SHE WAS ADMITTED AND PLACED ON A HEPARIN GTT. SHE COULD NOT RECEIVE TPA DUE TO A PREVIOUS BRAIN ANEURYSM REPAIR WITH COIL. SHE SPEND ANOTHER 2 WEEKS IN THE HOSP ON ASPIRIN, COUMADIN AND BRILINTA. HER LDH HAD STEADILY BEEN TRENDING DOWN, BUT REMAINED 1176 AT DISCHARGE. PALLIATIVE CARE WAS CONSULTED TO DISCUSS OPTIONS FOR GOING HOME. BETWEEN THE PT AND HER FAMILY, IT WAS DECIDED THE BEST DECISION WAS TO CHANGE THE PT'S CODE STATUS TO DNR AND TO GO HOME WITH HOSPICE. SHE WAS SENT HOME ON LOVENOX DAILY, COUMADIN, PLAVIX AND ASPIRIN. SHE WAS DISCHARGED HOME TO HOSPICE ON (B)(6) 2018. THE CLINIC RECEIVED A PHONE CALL FROM THE HOSPICE RN ON (B)(6) AND REPORTED THAT THE PT'S HUSBAND WAS CONCERNED DUE TO THE PT'S PROFOUND WEAKNESS AND CONFUSION FROM THE PREVIOUS NIGHT. THE HOSPICE RN REPORTED THAT THE PT HAD BEEN TAKING ZOFRAN AND ATIVAN FOR NAUSEA AND ANXIETY THAT SHE HAD BEEN EXPERIENCING. DR (B)(6), CARDIOLOGIST WAS NOTIFIED, BUT NO ORDERS WERE GIVEN. ON (B)(6) 2018, THE CLINIC RECEIVED ANOTHER PHONE CALL FROM THE HOSPICE RN STATING THE PT'S FAMILY WAS STATING THE PT HAD VERY LIMITED MOVEMENT ON THE LEFT SIDE AND THAT DR (B)(6) PREVIOUSLY TOLD THEM OF THE POSSIBILITY OF MINI-STROKES. THE RN WAS INSTRUCTED TO ASSESS THE PT, PERFORM NEURO CHECKS, VERIFY THAT THE PT HAD BEEN RECEIVING LOVENOX INJECTIONS AND CALL THE CLINIC BACK. THE HOSPICE RN CALLED BACK STATING THE PT'S RIGHT HAND HAD NO MOVEMENT OR GRIP, THE LEFT HAND HAD GOOD GRIP AND MOVEMENT. SHE REPORTED BILATERAL LOWER EXTREMITY WEAKNESS. PT WAS ALERT, BUT HAD TROUBLE GETTING WORDS OUT, TOOK A WHILE TO SAY SOMETHING, BUT SHE COULD SPEAK. PT EXPRESSED SHE DID NOT WANT TO COME TO THE HOSP AND IS STILL RECEIVING HER LOVENOX. NO ORDERS WERE GIVEN. THE CLINIC RECEIVED A PHONE CALL ON (B)(6) 2018 FROM THE HOSPICE RN REPORTING THE PT HAD PASSED. UPON EXAMINATION, THE PT WAS LYING IN BED, HAD NO RESPIRATIONS, NO HEART RATE AND NO VIABLE SIGNS OF LIFE. THE VAD NP WAS CALLED AND GAVE INSTRUCTIONS ON HOW TO DECOMMISSION THE LVAD.