HospitalInspections.org

Based on staff interviews, and review of facility documents, it was determined that the facility failed to ensure a patient acuity system is in place to ensure the assignment of nursing care is in accordance with the patients' needs.

Findings include:

Facility policy titled, "Nursing Staffing Procedure" (undated), states, "Objective: To provide appropriate personnel for each nursing care unit commensurate with the patient care requirements, staff expertise, availability of support services and method of patient care delivery. ... d. The Staffing Level Guidelines will be utilized as a reference as to the general staffing needs as related to census. ... There will be at least an overall average of 65% of direct patient care hours on an inpatient unit provided by licensed staff. Other elements to be taken into consideration to determine staff levels: i. Patient factors: a) Levels of intensity of the patients b) patient turnover and activity (admissions, discharges, transfers, etc.) c) Age and functional ability ... f) Severity and urgency of admitting condition ... iii. Other a) Availability of support staff..."

On 3/20/23 at 10:01 AM, during a tour of 5 Hayes (Med-Surg/Oncology unit), the unit census was 20 and there were four nurses on the schedule, plus one clinical coordinator, and there was one Nurse's aide. At 10:25 AM, S3 (Clinical Supervisor) stated during the interview that patient assignments are "blocked" (consecutive patient rooms) starting the beginning of the year (2023). S3 confirmed that unit staffing was by the number of patients in the census, not by acuity. During the interview, S3 stated, that private/isolation rooms are clustered in one area. During the tour of the unit, it was determined that private rooms are Room #65-76. S3 stated that if you are assigned to that block, the nurse will get most of the isolation patients. During the interview, S3 confirmed that there was no acuity tool utilized in the unit.

On 3/20/23 at 11:07 AM, a tour of 5 Stainton nursing unit was conducted in the presence of S5 (Nurse Manager) and S6 (Clinical Supervisor). The census at the time of the survey was 25 with a total bed capacity of 32. There were 4 nurses scheduled and three scheduled Nurse's Aides (who was rotating on a 1:1 observation patient). Upon interview at 11:11 AM, S6 stated that the unit cares for patients with tracheostomies on chronic vents; medication drips such as heparin drips; and medical-surgical patients. S6 confirmed that the unit does block assignments. During the interview S5 and S6 confirmed that the unit staffing is not based on acuity. At 11:14 AM, S6 stated that there was a charge nurse worksheet that reflects the unit's acuity, however, it does not factor in staffing. Nursing assignments were still blocked assignments.