HospitalInspections.org

Based on observation, medical record review and staff interview it was determined the Registered Nurse (RN) failed to supervise and evaluate care related to providing care per physician orders and/or implementing nursing interventions for six (#9, #10, #19, #21, #22, #31) of 36 patients sampled. This practice does not ensure patient goals are met and may to a prolonged hospital stay.

Findings include:

1. Patient #10's record revealed the patient had pressure ulcers on coccyx and right buttock. The facility's Pressure Ulcer Prevention Policy #H-WC 03-001 revised 2/2012 at 1(A) (i) stated "turn every two hours according to established facility routine." Nursing notes dated 2/20/12 revealed repositioning was noted at the following times:
4:00 a.m. reposition to left side
7:02 a.m.-supine
8:30 a.m.-supine (indicating the patient remained in the same position)
10:00 a.m.-supine
12:00 p.m.-supine
2:00 p.m. supine
4:00 p.m.-supine
7:36 p.m.-supine
8:00 p.m.-left side
The patient remained on her back for twelve and one half hours from approximately 7:02 a.m. until being turned to her left side at 8:00 p.m.
Nursing documentation dated 2/22/12 revealed repositioning was noted at the following times:
3:54 a.m.-reposition to left side
7:15 a.m.-supine
8:00 a.m.-supine
10:00 a.m.-supine12:00 p.m.-supine
2:00 p.m.-supine
4:00 p.m.-left side
The documentation showed the patient remained on her back for eight and three quarters hours from 7:15 a.m. until being turned to her left side at 4:00 p.m.

2. Patient #21's plan of care dated 4/12/12 revealed potential alteration in skin integrity. The facility's Pressure Ulcer Prevention Policy #H-WC 03-001" revised 2/2012 at 1(A)(i) stated "turn every two hours according to established facility routine. Nursing documentation dated 4/11/12 revealed repositioning was noted at the following times:
8:01 a.m.-right side
12:00 p.m.-right side
1:24 p.m.-supine
The nursing documentation indicated the patient remained on her right side for approximately five and one half hours from 8:01 a.m. until being turned to her back at 1:24 p.m.

3. Patient #31's record revealed the patient had pressure ulcers on the coccyx, perineum/buttocks and right lateral 5th metatarsal. The facility's Pressure Ulcer Prevention Policy #H-WC 03-001 revised 2/2012 at 1(A)(i) stated "turn every two hours according to established facility routine. " Nursing documentation dated 3/17/12 revealed repositioning was noted at the following times:
2:00 p.m.-repositioned to right side
4:00 p.m.-left side
5:30 p.m.-left side
8:00 p.m.-left side
10:00 p.m.-right side
The documentation showed the patient remained on her left side for six hours from 4:00 p.m. until being turned at 10:00 p.m.

4. Five (#9, #10, #19, #22, #31) of 8 patients in the Intensive Care Unit (ICU) had orders for Surface therapy: alternating pressure reducing surface; cycle time five minutes.

On 4/11/12 at 2:45 p.m. patient # 19 had alternating pressure setting set at 20 minutes. RN documentation on 4/11/12 at 10:19 a.m. revealed "executed as ordered".

On 4/12 /12 at 11:30 a.m. the patient #9 had alternating pressure setting set at 7 minutes. RN documentation on 4/12/12 at 9:22 a.m. revealed "executed as ordered."

On 4/12/12 at 11:35 a.m. patient # 10 had alternating pressure setting set at 1 minute. RN documentation on 4/12/12 at 10:00 a.m. revealed "executed as ordered".

On 4/12/12 at 11:40 a.m. patient # 22 had alternating pressure setting set at 10 minutes. RN documentation on 4/12/12 at 9:08 a.m. revealed "executed as ordered."

On 4/12/12 at 11:45 a.m. patient # 31 had alternating pressure setting set at 1 minute. RN documentation on 4/12/12 at 10:00 a.m. revealed "executed as ordered."

An interview with Nurse Manager of the ICU on 4/11/12 at 2:45 p.m. and on 4/12/12 at 11:45 a.m. confirmed the alternating pressure settings stated above.

Interview with an ICU staff RN on 4/12/12 at 1:50 p.m. revealed that nursing documentation was done once per shift to "acknowledge the patient was on the mattress at the correct setting and chart executed as ordered".