HospitalInspections.org

Based on interview and record the facility failed to ensure that the nursing care and interventions were appropriate to meet the needs in 1 of 9 sampled patients (SP#4).

Findings include:

Clinical record review of SP#4 conducted on 11-06-2013 revealed an admission date of 10-04-2013 due to a PICC (Peripherally Inserted Central Catheter) Dislodgement and the patient has a pertinent medical history for COPD (Chronic Obstructive Pulmonary Disease).
Review of SP#4 record conducted on 01-02-14 showed an MD (physician's) order dated 10-04-13 at 19:29 pm which has that the initial order for the medical surgical unit. It was changed on 10-04-13 at 20:38 pm to cardiac monitor. Review of the telemetry alarm record showed that the patient was placed on telemetry box on 10-05-13 at 23:43 pm.
Further review of the 8 north telemetry Log dated 10/07/2013 on the 20:00 pm-07:00 am shift revealed that SP#4 was discharged from the (telemetry box) monitor at 20:00 pm. Review of the Nurses notes dated 10/07/2013 at 19: 40 pm the nurse has documented that the Doctor (named) aware of patient HGB (hemoglobin) being 7.7 and HCT (hematocrit) 24.8. But patient is still to be discharged. Review of SP#4 adult Shift Assessment dated 10/07/2013 at 20:00 pm also revealed that in the section for the respiratory assessment has dyspnea (the sensation of difficult or uncomfortable breathing) on exertion. The next entry on the nursing notes at 10/08/2013 at 00:01 am has, found patient unresponsive, sitting on the toilet. Code blue called. Wife at bedside.

Interview conducted on 01-03-14 at 4:20pm with RN#3 she stated that the vital signs were taken by the PCA (patient care technician) in her presence and patient had oxygen per nasal cannula. She stated Then I did the discharge papers and after that I went back to let the patient sign the papers but patient was in the bathroom (BR) and so I said, OK, I ' ll give you some privacy and I ' ll come back. " After 15 minutes I came back to the room and knocked at the BR door and I said " Are you OK (name of SP#4) and he said he was thinking of taking a shower. I explained that he has a dressing on his foot and he could slip with the dressing on and I could not duplicate the dressing done by the podiatrist and he said, " OK, I ' ll just freshen up " . At the same time I had another admission. I was almost finished when I got called that my patient was unresponsive and code blue was called. He did not sound like he was short of breath when he was talking from inside the Bathroom. Earlier, patient refused respiratory treatment but I insisted and patient took it. Also, earlier I saw the patient sitting at the edge of the bed short of breath and when asked he just went to the Bathroom and I instructed patient to use oxygen and emphasized that it has extension and could reach the BR.

Interview with the ACNO (Assistant Chief Nursing Officer) conducted on 01-02-14 at 09:30 am revealed that he also reviewed SP#4 medical records. He stated that this is an isolated case as majority of the patients are discharged within 60 minutes turn around or at reasonable amount of time. That the patients once order a discharge is received that they want to go home right away. But in this case, the wife requested for patient to stay for late pick-up because of her work schedule as she works till 11 pm.
Further interview with the ACNO conducted on 01-02-14 revealed that regarding the policy and procedure regarding telemetry removal, there was no change but will continue to re-evaluate based on patient ' s safety. Review of the policy and procedure title: Telemetry transmitter unit count showed: Procedure#3 Once a discharge order is written, transmitter must be removed by the nurse and brought to the monitor technician immediately.