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A nursing home in Mount Pleasant is facing possible fines after a woman died of internal bleeding just two weeks after moving into the facility.
The Iowa Department of Inspections and Appeals cited Arbor Court nursing staff for failing to properly respond to a warning from their electronic system about a potential bad interaction between two medications administered to a female resident.
When combined, the two drugs increased the risk of internal bleeding.
The resident was admitted to Arbor Court on Nov. 30, 2022. On Dec. 5, a week later, a progress note documents that the resident was experiencing an elevated temperature, nausea and dizziness.
On that same day, a separate progress note generated by the Electronic Health Record warned nursing staff of a possible negative drug interaction between the woman's blood thinning medication and an antibiotic.
"The EHR identified the interaction as a moderate severity," a DIA report reads.
However, there is no documentation of the nursing staff acknowledging the warning or informing the woman's primary care physician.
On Dec. 12, 2022, the woman was admitted to the emergency room after experiencing new bruising and bleeding from a wound on her sacrum.
Doctors discovered the woman had a gastrointestinal bleed and had lost approximately "four units" of blood, or 45% of the blood an average-sized woman might have.
The hospital was attempting to provide the woman with additional blood when she passed away, according to reports.
An investigation into the woman's death began on Dec. 14, including a review of medical records as well as interviews with the woman's primary care physician, nursing staff and emergency room staff.
During these interviews, inspectors found that the woman's primary care provider had prescribed the two medications to the woman many times.
In addition, Arbor Court's director of nursing allegedly told inspectors that nursing staff "could either use [the computer] or their personal cell phones to Google medications if they had a question about dosages or interactions."
As a result of these findings, the state cited Arbor Court for not ensuring the resident's drug regimen was free from unnecessary drugs.
An unnecessary drug is defined as any drug when used in excessive dose, for an excessive duration, without adequate monitoring, without adequate indications for use or when there is potential for adverse consequences.
The state imposed a fine of $17,500, which is currently under review by the federal Centers for Medicare and Medicaid Services, the Iowa Capital Dispatch reports.
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