HospitalInspections.org

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Based on observation, interview, and document review, the hospital failed to ensure the Hospital operated under one unified nursing service under the direction of one Registered Nurse who was responsible for the quality of care provided to hospital patients by hospital and non-hospital nursing staff.

Failure to ensure that Nursing Services are provided under the direction of one hospital-wide nursing service under the direction of one Registered Nurse accountable for the quality of nursing care provided to its patient's places patients at risk for inconsistent or inadequate care, adverse outcomes, and death.

Findings included:

1. The hospital failed to ensure that Providence Sacred Heart Medical Center operated with one hospital-wide Nursing Service, and failed to ensure that a single nursing service was under the direction of one Registered Nurse (RN) responsible for the operation of the services and the quality of the patient care provided by nursing services.

Cross Reference: A0386

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Based on interview and document review, the hospital failed to ensure that Providence Sacred Heart Medical Center operated with one hospital-wide Nursing Service, and failed to ensure that a single nursing service was under the direction of one Registered Nurse (RN) responsible for the operation of the service and the quality of the patient care provided by nursing services.

Failure to ensure that Nursing Services are provided under the direction of one hospital-wide nursing service under the direction of one Registered Nurse places patients at risk for suboptimal care, adverse outcomes, and death.

Findings included:

1. Document review of the hospital's organizational chart titled, "Inland Northwest Washington Organizational Chart," no date, showed the following:

a. Departments including Acute Care, Critical Care/Telemetry, Emergency Services, Trauma Services, and Women & Children's report through the Sacred Heart Chief Nursing Officer included:

b. Perioperative Services report through the Chief Operating Officer (Staff #517) for Holy Family Hospital (a separately licensed and certified hospital).

c. Transplant Services and the Heart Institute report through the Chief Medical Officer for Inland Northwest Service Area (Staff #514).

d. Cardiovascular Procedural Services and Perioperative Services-Director report to the Executive Director of Perioperative Services (Staff #518). Staff #518 reports to the Chief Operating Officer at Holy Family Hospital (Staff #517) (a separately licensed and certified hospital).

Document review of the Transplant Hospital's organizational chart titled, "Organizational Chart," no date, showed that Transplant services and staff report through the Chief Medical Officer (Staff #514).

2. On 07/10/24 at 9:00 AM, Surveyor #5 interviewed the Clinic Nurse Manager (Staff #505) related to oversight and administrative structure for the Transplant Program. At this time, Staff #505 stated that the outpatient clinics were under oversight of Providence Medical Group, and she reported to the Transplant Program Director (Staff #513) who was employed by Providence Medical Group and reported to the Chief Medical Officer (#514). She stated that the Transplant program oversight was provided by the Chief Medical Officer Staff (#514). Staff #505 verified there was no contract or agreement as they were all Providence Employees.

3. On 07/10/24 at 11:00 AM, Surveyor #5 and the Sacred Heart Medical Center Chief Nursing Officer (Staff #514) reviewed the Inland Northwest Washington organizational chart provided to the Surveyor and the Transplant Hospital organizational chart and discussed oversight of Nursing Services by staff providing care to patients at Sacred Heart Medical Center and Children's Hospital (PSCMC) including the Transplant Program.

4. At the time of the review, Staff #514 verified that the Transplant Program nursing staff are employees of PSCMC, but that the Transplant Program Manager (Staff #513) is an employee of Providence Medical Group, and oversight of Providence Medical Group is provided by the Chief Medical Officer (CMO) who is the CMO for the Service Area. Staff #514 stated that Staff #513 evaluated the nursing care by staff providing care at the Transplant Center. Staff #514 verified that he was not on the organizational chart reporting or oversight structure for the transplant hospital.

Surveyor #5 found no evidence that Sacred Heart Medical Center and Children's Hospital operated with one nursing service hospital-wide under the direction of one Registered Nurse.

5. On 07/11/24 at 10:00 AM, during interview with Staff #514, Surveyor #5 noted that organizational chart showed that Perioperative Services reported through the Chief Operating Officer (Staff #517) at Holy Family Hospital a separately licensed and certified hospital.

6. At this time, Staff #514 verified that Perioperative Services at Sacred Heart Medical Center and Children's Hospital (Preoperative, Intraoperative, and Postoperative Services/Care), Cardiac Cath Lab, Interventional Radiology, Electrophysiology lab, and Endoscopy report up through the Chief Operating Officer at Holy Family Hospital (a separately licensed and certified hospital).

Surveyor #5 found no evidence that Sacred Heart Medical Center and Children's Hospital operated with one nursing service hospital-wide under the direction of one Registered Nurse.


7. On 08/01/24 at 12:00 PM, during interview with Surveyor #5, Staff #514 verified that the organizational chart provided to the Surveyor showed organizational flow for the Inland Northwest Washington service area which included Sacred Heart Medical Center and Children's Hospital, St Lukes Rehabilitation Medical Center, and Holy Family Hospital. Staff #514 stated that the Chief Executive Officer (Staff #519) provided oversight for the Inland Northwest Washington Service area.

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