HospitalInspections.org

Based on medical record review, policy review, and staff interview the facility failed to ensure ongoing evaluation of emergency room patients awaiting a medical screening examination as per their facility policy. 5 of 20 patients triaged as ESI 2 patients did not have reevaluation and assessment of their vital signs as per their own facility policy.

Findings were:

Review of medical records for 20 patients receiving services in the emergency department revealed 5 patients (#1, #2, #18, #19, & #20) did not have their vital signs reassessed every 30 minutes until assigned a treatment room as per facility policy.

Facility policy titled "Triage Assessment" states in part:
"POLICY:
All individuals who come to the emergency department and request examination or treatment will be promptly assessed by a qualified nurse to determine the appropriate order in which the individual will receive a medical screening examination based upon the acuity of the individual's presenting complaint.
PURPOSE:
To provide guidelines for accurately assessing triage patients presenting to the Emergency Department.
PROCEDURE:
STEPS:
1. Individuals who report to the Emergency Department will receive a medical screening examination based upon the acuity of the individual's presenting complaints.
2. Patients will be triaged utilizing the Emergency Severity Index ....
1. The following are routine reassessment criteria; however immediate reassessment and re-triage shall occur in patient deterioration is suspected.
a. Patients categorized ESI level 1 are escorted to the treatment area and assigned to a primary nurse.
b. Patients categorized ESI level 2 are escorted to the treatment area whenever possible and assigned to a primary nurse upon completion of triage. In the event that the patient cannot be immediately escorted to the treatment area, the patient will be reassessed every 30 minutes.
c. Patients in the waiting area categorized as ESI level 3 must be reassessed every 4 hours following the initial triage time.
d. Patients in the waiting area categorized as ESI level 4 & 5 must be reassessed every 8 hours following the initial triage time.
e. Reassessment includes a repeat of vital signs, excluding temperature unless indicated.
2. All monitoring and interventions will be documented on the ED record and patient care notes.
3. The nurse in charge in collaboration with the triage nurse will assist in keeping the patient's family members informed of the patient's condition and keeping patients updated as to delays at least every two hours.
4. It is the responsibility of the triage nurse in collaboration with the nurse in charge to change the order in which patients are medically screened and treated based upon department activity changes and/or any changes in individual patient conditions.
5. Nursing staff documents the modes of arrival, primary, secondary, and ongoing assessments on the patient care notes. During and at the end of each shift, the nurse in charge will be responsible for the review and evaluation of all triage records completed by the registered nurses."

In an interview with staff #2 she acknowledged the staff did not follow their own policy in reassessment of patients every 30 minutes with an ESI 2 designation who remained in the waiting room for an extended period of time.