HospitalInspections.org

Based on the seriousness of the non-compliance and the potential effect on patient outcome, the facility failed to substantially comply with this condition.

The findings were:

482.23(b)(6) Tag A-0398 Nursing Services: Supervision of Contract Staff
The information reviewed during the survey provided evidence the facility failed to ensure staff followed approved policy for ensuring patient telemetry monitoring is not removed without a doctor's order and to ensure a patient had IV access at all times while on telemetry.

A discussion took place with the survey team and the facility's administrative staff (EMP1 and EMP2) regarding the survey team's concerns related to Nursing Services on February 2, 2024, at 09:30 AM.

Cross reference
482.23(b)(6) Nursing Services: Supervision of Contract Staff

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Based on review of facility documents, medical record (MR), staff interview (EMP) and observation it was determined the facility failed to ensure staff followed hospital policies and procedures for ensuring telemetry patients have intravenous (IV) access at all times and remain on continuous monitoring according to the doctors order.

Findings include:

On January 25, 2024, review of facility policy "Continuous Cardiac Monitoring Guidelines via Telemetry" effective August 2023 revealed "Scope and Purpose - To provide guidelines for telemetry monitoring. Policy - To provide skilled nursing care to patients who require cardiac monitoring. ... C. Care of the Patient ... 6. Patients are not to be taken off telemetry during a.m. care, ambulating to the bathroom, or in the hall, dialysis treatments, etc. (unless an order is written by a physician). 7. All telemetry patients must have a patent intravenous catheter. ..."

On January 25, 2024, review of MR1 revealed an order entered by EMP7 on December 30, 2023, at 4:40 AM for Continuous Cardiac Monitoring. On January 4, 2024, at 8:55 AM the patient's monitor rhythm alarmed asystole (heart stop beating) patient was unresponsive and a code blue was called. The patient first dose of epinephrine had to be given via intraosseous access (IO) (drilling a hole through the bone cortex) due to patient not having intravenous (IV) access.

Interview with EMP6 on January 24, 2024, EMP6 revealed upon starting shift at 6:55 AM it was reported to EMP6 that patient did not have IV access due to the patient pulling it out during night shift. Further interview confirmed a message was not sent to the IV team to re-insert IV access on night shift or by EMP6.

Interview with EMP1 on January 25, 2024, EMP1 confirmed all information above is accurate and complete.

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Observation on January 25, 2024, on unit 1 North at 10:40 AM, MR2 telemetry monitor alarm was sounding with the message "Leads off" from 10:40 AM until 10:45 AM.

Interview with EMP3 on January 25, 2024, EMP3 confirmed MR2 leads were off because MR2 was returning from having a Magnetic Resonance Image (MRI) scan appointment and MR2 was taken off telemetry to go have MRI scan done.

Review of MR2 on January 25, 2024, revealed an order entered by EMP4 on January 19, 2024, at 1:54 PM for Continuous Cardiac Monitoring; an order entered by EMP5 on January 24, 2024, at 3:14 PM for MRI of pelvis with and without contrast for January 25, 2024, at 9:00 AM. There was no order found in MR2 to take the patient off telemetry to go to the appointment.

Interview with EMP1 on January 25, 2024, EMP1 confirmed MR2 did not have an order for the patient to be taken of telemetry to go for the MRI scan and the facility policy was not followed.