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Based on observation, interview, and record review, the facility failed to ensure, for three of four sampled patients (Patients 27, 28, and 30), the patients and/or the patients' responsible party (RP) received information and/or education on telesitter monitoring (a remote patient observation system used to enable audio and visual monitoring of patients) when Patients 27, 28, and 30 were started on telesitter monitoring.

This failure resulted in the patients' right to personal privacy to not be exercised.

Findings:

1. During an observation on May 10, 2021, at 11:23 a.m., conducted with Charge Nurse (CN) 1, Patient 27 was observed lying in bed, asleep, with a telesitter monitoring system actively in use in the patient's room. During a concurrent interview, CN 1 stated Patient 27 was on telesitter monitoring for risk of falls.

During a review of Patient 27's record on May 10, 2021, at 11:40 a.m., conducted with CN 1, the "History and Physical" indicated Patient 27 was admitted to the facility on May 7, 2021, with a chief complaint of lower extremities and scrotal swelling.

The "Telesitter Patient Admission Report Form" indicated Patient 27's telesitter monitoring started on May 8, 2021, at 12:52 a.m., for fall prevention.

There was no documented evidence Patient 27 received telesitter information and/or education on telesitter monitoring.

During an interview on May 10, 2021, at 12:25 p.m., conducted with Director of Nursing (DON) 1, DON 1 stated Patient 27 should be informed and educated when the telesitter monitoring was initiated.

2. During an observation on May 10, 2021, at 11:26 a.m., conducted with Charge Nurse (CN) 1, Patient 28 was observed lying in bed, asleep, with a telesitter monitoring system actively in use in the patient's room. During a concurrent interview, CN 1 stated Patient 28 was on telesitter monitoring for risk of falls.

During a review of Patient 28's record on May 10, 2021, at 12 p.m., conducted with CN 1, the "History and Physical" indicated Patient 28 was brought in by the patient's RP to the facility on May 6, 2021, with a chief complaint of weakness and right side pain.

The "Telesitter Patient Admission Report Form" indicated Patient 28's telesitter monitoring started on May 8, 2021, at 8:16 a.m., for fall prevention.

There was no documented evidence Patient 28 or the patient's RP received telesitter information and/or education on telesitter monitoring.

During an interview on May 10, 2021, at 12:25 p.m., conducted with Director of Nursing (DON) 1, DON 1 stated Patient 28 and/or patient's RP should be informed and educated when telesitter monitoring was initiated for Patient 28.

3. During an observation on May 10, 2021, at 2 p.m., conducted with Director of Nursing (DON) 2, Patient 30 was observed lying in bed, asleep, with a tracheostomy tube (a tube inserted through a cut in the neck to allow entry of air into the lungs). A telesitter monitoring system was observed actively in use in the patient's room. During a concurrent interview, DON 2 stated Patient 30 was on telesitter monitoring due to pulling of the tracheostomy tube.

During a review of Patient 30's record on May 10, 2021, at 2:15 p.m., conducted with DON 2, the "History and Physical" indicated Patient 30 was transferred to the facility on April 4, 2021, from another acute care hospital.

The "Telesitter Patient Admission Report Form" indicated Patient 30's telesitter monitoring started on April 30, 2021, at 5:36 a.m., for the prevention of pulling out of a medical device.

There was no documented evidence Patient 30 or the patient's RP received telesitter information and/or education on telesitter monitoring.

In a concurrent interview, DON 2 stated Patient 30 or and/or patient's RP should be informed and educated when telesitter monitoring was initiated for Patient 30.

During a review of the undated facility document titled, "Telesitter: Patient Monitoring Technology," the facility document indicated, "...Initiation of (name of the telesitter monitoring system) Video Monitoring...Primary Nurse discusses with Charge RN inclusion criteria...NHS (Nursing House Supervisor) will confirm the availability of the Telesitter...RN faxes the completed Admission form to the VMT (Video Monitor Tech)...Primary Nurse gives patient report to Video Monitor Tech...Primary Nurse educates patient and family...RN will introduce the VMT to the pt (patient)..."

Based on observation, interview, and record review, the facility failed to ensure, for two sampled patients (Patients 31 and 32), the facility's policy and procedure (P&P) for pain management was implemented when Patients 31's and 32's pain were not assessed consistently.

This failure had the potential to result in Patients 31's and 32's pain to not be managed appropriately and may result in the delay of the patients' healing and recovery from their medical health conditions.

Findings:

1. During an observation on May 10, 2021, at 1:55 p.m., conducted with Director of Nursing (DON) 2, Patient 31 was observed lying in bed, awake, alert, and with a cervical collar (used for support of the spine and head for neck injuries and/or neck pain) around her neck. Patient 31 was observed to be crying as she stated, "I'm having so much pain on my back and on my neck." DON 2 was observed to tell Patient 31 she will let the nurse know to check if pain medication could be given to the patient. Patient 31 was observed to respond to DON 2 with "please check."

During a review of Patient 31's record on May 10, 2021, at 2:25 p.m., conducted with DON 2, the "History and Physical" indicated Patient 31 was admitted to the facility on May 9, 2021, with a chief complaint of fall.

The facility document titled, "Medication," dated May 10, 2021, at 12:34 p.m., indicated Patient 31 was to be given Percocet (narcotic medication for pain) 5-325 mg (milligram, unit of measurement) one tablet by mouth every six hours as needed for severe pain.

The "Pain Monitoring Flowsheet" indicated Patient 31's pain was last assessed on May 10, 2021, between 4 a.m. to 5 a.m.

There was no documented evidence Patient 31's pain was assessed on May 10, 2021, between 5 a.m. to 2:25 p.m. (up to the time of record review, a total of nine hours and 25 minutes).

In a concurrent interview, DON 2 stated the patient's pain should be assessed when the patient's vital signs (VS; temperature, heart rate, respiratory rate, and blood pressure) were taken or as needed when the patient was in pain or pain interventions were provided.

DON 2 stated in the nursing unit, the patient's VS were checked every four hours. DON 2 stated Patient 31's pain assessment should have been done every four hours.

During an interview on May 10, 2021, at 3:10 p.m., conducted with Registered Nurse (RN) 1, RN 1 stated she was the assigned nurse for Patient 31.

RN 1 stated Patient 31's pain should be assessed every four hours with the VS.

During a review of Patient 31's record on May 12, 2021, the "Medication Administration Record" indicated Patient 31 received her first dose of Percocet on May 10, 2021, at 4 p.m., (two hours and five minutes after Patient 31 was observed crying in pain).

There was no documented evidence Patient 31 received pain medication from the time Percocet was ordered on May 10, 2021, at 12:34 p.m., up to May 10, 2021, at 4 p.m.

2. During an observation on May 11, 2021, at 9:35 a.m., conducted with Charge Nurse (CN) 2, Patient 32 was observed lying in bed, awake, alert, moaning, and grunting. During a concurrent interview, Patient 32 stated he had pain in his abdomen 10 out of 10 (a pain score of 7 to 10 would indicate severe pain).

During a review of Patient 32's record on May 11, 2021, at 9:50 a.m., conducted with CN 2, the "History and Physical" indicated Patient 32 was admitted to the facility on April 21, 2021, with a chief complaint of shortness of breath and edema (swelling).

a. The "Pain Monitoring Flowsheet" indicated the Patient 32's pain was assessed on the following times:

i. May 4, 2021, at 6 a.m.;

-- May 4, 2021, at 8 p.m. (a total of 14 hours after Patient 32's last pain assessment);

-- May 5, 2021, at 2 a.m. (a total of six hours after Patient 32's last pain assessment);

ii. May 5, 2021, at 6 a.m.;

-- May 5, 2021, 8:34 p.m. (a total of 14 hours and 34 minutes after Patient 32's last pain assessment);

iii. May 6, 2021, at 12 p.m.;

-- May 6, 2021, at 8 p.m. (a total of eight hours after Patient 32's last pain assessment);

iv. May 10, 2021, at 6 a.m.; and

-- May 10, 2021, at 9:15 p.m. (a total of 15 hours and 15 minutes after Patient 32's last pain assessment);

In a concurrent interview, CN 2 stated the patient's pain should be assessed when the patient's vital signs (VS - temperature, heart rate, respiratory rate, and blood pressure) were taken or as needed when the patient was in pain or pain interventions were provided.

CN 2 stated in the nursing unit the patient's VS were checked every four hours. CN 2 stated Patient 32's pain was not assessed consistently every four hours.

During a review of the facility's P&P titled, "Pain Management," dated March 29, 2019, the P&P indicated, "...(name of the facility) recognizes the patient's right to pain relief and supports a multidisciplinary approach to pain assessment and management. The purpose of this policy is to establish standards for pain assessment and management...

The physician...nurse, shall assess the presence of pain on all patients upon initial evaluation, and or assessment and at an ongoing basis per physicians orders and whenever necessary...

The pain assessment tool utilized shall be consistent with the patient's developmental and intellectual capacity. Patient self-report shall be utilized whenever possible..."