HospitalInspections.org

Based on review of facility policies, medical records (MR), and staff interviews (EMP) it was determined the facility failed to ensure that nursing personnel followed facility policy for patients on cardiac monitoring in three of ten medical records reviewed (MR1, MR4, and MR8).

Findings include:

On July 2, 2024, review of policy "Telemetry Utilization" with an effective date of October 6, 2021, revealed "POLICY: Telemetry is a supportive tool when taking care of patients who may be at risk for abnormal heart activity. For every patient on telemetry there needs to be a daily assessment for the need of continuous Cardiac monitoring. II. PURPOSE: To guide Crozer Health clinicians in determining which patients require arrhythmia monitoring via telemetry; specifically, initiation, duration, and discontinuation. III. SCOPE: Clinical Practitioners (RNs, MDs, Dos, APRNs, Pas) involved in the care of the patients for whom arrhythmia monitoring via telemetry is being considered at CCMC only. ... V. PROCEDURE: 1. Night shift: utilizing the Daily Telemetry Checklist, each nurse will add their telemetry Patients ... B. Nurse will check Indications met or Does not meet Indications. 2. Day shift: by 9am each nurse will review the list for appropriate outcomes of their patients A. Indications met-continue telemetry and place order per protocol. B. Does not meet Indications-Discontinue Telemetry, make general care and place order per protocol. ... 4. Daily Telemetry Checklist ... B. Fax the completed sheet to the Hospitalist' Office where all Hospitalist will be alerted about their patients through office team. ... VI. Daily Telemetry Checklist with Appropriate Indications on back. ... 6. Kept in a binder each day for future reference. ... Telemetry Discontinuation Patients on telemetry monitoring will be evaluated by nursing in accordance with the following process. Telemetry Order will automatically discontinue based on the ordered duration (24/48/72 hours, indefinite, or clinical outcome achieved). One hour prior to the order expiration, the Cardiac Telemetry Assessment form task will fire. This assessment includes the following: o RN to assess for safe discontinuation of telemetry or need for new order based on set criteria (vital signs and/or a significant change in clinical condition) ... o If VS unstable, continue with telemetry monitoring. o If the patient meet the clinical criteria the telemetry will be discontinued by the RN. o If the patient does not meet the clinical criteria the RN will contact the provider to determine if another order needs to be placed to continue telemetry."

On July 2, 2024, review of policy "Cardiac Monitoring" with an effective date of May 12, 2022, revealed "POLICY: Monitoring of vital signs, especially heart rate and rhythm, is accomplished through various continuous monitoring devices. A clinical alarm is defined as a patient generated or activated audible and/or visual notification that a patient's immediate physiological health status is, or could be, life threatening. ... All patients outside the critical care units on telemetry will have an order for telemetry monitoring. All orders remain active until discontinued. ... 9. Standby A. The Standby function allows the clinician to suspend monitoring on a patient. i. While in 'Standby' the patient is not monitored at the central station; ... ii. Patients should only be placed in 'Standby' when/if a patient travels off the unit on a stand-alone transport monitor, arrives to a department where the telemetry monitor is removed (i.e. MRI, OR) or during a bedside procedure where a portable bedside monitor is used and appropriate clinician is in attendance. ..."

Review of MR1 revealed the Cardiac Telemetry Assessment for June 6, 2024, for Telemetry Heart Rate DC (discharge) Criteria trigger "Patient does not meet criteria to automatically discontinue telemetry. Contact provider to evaluate need for new order." Further review of MR1 revealed there was not a new order to continue telemetry. Nursing Progress Note dated June 9, 2024, at 07:21 for MR1 stated "... Pt [patient] had continuously removed the monitor throughout the night, and was on and off standby as monitor was on and off ..." Patient was found at 0615 with no pulse. There was no physician order to put the telemetry monitoring on standby.

Interview with EMP5 on July 2, 2024, confirmed the telemetry order was not renewed.

Interview with EMP 7 on July 3, 2024, confirmed there was no order to place telemetry on standby.

Review of MR4 revealed an order for telemetry monitoring on May 29, 2024, at 0941 for 24 hours. On May 30, 2024, at 0840 met criteria to continue telemetry monitoring and needed a renewed order. No new order to renew telemetry was found in the medical record. Patient was kept on telemetry, verified by printed out telemetry strips, without an order.

Interview with EMP9 and EMP10, on July 3, 2024, at 11:00 AM confirmed that the telemetry order was not renewed and telemetry was continued without an order.

Review of MR8 revealed the Cardiac Telemetry assessment triggered but was not completed. Patient was put on telemetry, verified by printed out telemetry strips, without a completed assessment or doctors order for telemetry.

Interview with EMP5 on July 3, 2024, at 10:00 AM confirmed the Cardiac Telemetry assessment was not completed and there was not an order for telemetry for MR8.