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Based on record review and interview the hospital failed to ensure that a patient received care in a safe setting by failing to ensure that a patient who was initially assessed as high risk for fall was found lying on the floor for 1 of 1 patients in a total sample of 20 (#2). Findings:
The medical record of (Patient #2) was reviewed. Review of the medical record revealed (Patient #2) was a 77 y/o who reported to the ER on 12/01/09 at 1325 (1:25 p.m) with a chief complaint of impaired speech. Documentation reflected the patient was alert and oriented to person, place and time, was able to understand instructions. Patient #2 had a past medical history of hypertension and a surgical history of cardiac bypass. Review of the ER record dated 12/01/09 reflected (Patient #2) had a blood pressure reading of 229/104 and was placed on a code purple (Stroke Protocol). The patient was ordered and recieved Aspirin 325 mg, Plavix 300 mg and Coumadin 5 mg by mouth at 1550 (3:50 p.m.). A CT scan was ordered and completed as per the hospital's Stroke Protocol. The results were reviewed, and the report reflected that (Patient #2) had an old small left CVA and an old medial right frontal small CVA. The impression reflected "Age related white matter changes and old CVA finding noted with no acute findings."

(Patient #2) was admitted to the hospital's Telemetry unit on 12/01/09 under the care of #S4, M.D., Family Practice.
Review of an initial assessment completed on 12/1/09 at 1736 (5:36 p.m.) reflected (Patient #2) was monitored per Telemetry, assessed as high risk for fall and interventions for falls were initiated. Review of the admission assessment comment reflected (Patient #2) was admitted for sudden onset of speech difficulty at home. It was noted that the patient was having trouble with making sentences but was oriented to person, place and time. It was also noted that the patient was able to move all extremities equally. Upper and lower limb movements were bilaterally strong with strong bilateral hand grasp. Patient #2's Glasgow Coma Scale was 15 which reflected the patient opened eyes spontaneously, was oriented and obeyed commands. Documentation reflected that the patient was ambulatory with the use of a walker.
Review of an assessment completed on 12/1/09 at 2345 (11:45 p.m.) reflected Patient #2 remained at high risk for falls. Review of an assessment completed by #S7, RN on 12/2/09 at 0730 (7:30 a.m.) revealed (Patient #2) had bilateral weakness to upper and lower limbs with bilateral weak hand grasps. Patient #2's Glasgow Coma Scale reflected a total score of 14. The patient was noted to open eyes to sound, was oriented and obeyed commands. The patient was also noted to have bilateral full range of motion.
Review of a nursing assessment completed on 12/2/09 at 2000 (8:00 p.m.) completed by #S8, LPN reflected that (Patient #2) was oriented to person only. Further documentation reflected (Patient #2) had bilateral weakness to upper and lower limbs with bilateral weak hand grasps. There was no documentation to reflect a Glasgow Coma Scale was completed at the above time. The patient was noted to be unsteady. Documentation reflected the nurse failed to assess the patient as high risk for falls.
The following entry noted on the nurse's assessment dated 12/2/09 at 2330 (11:30 p.m.) completed by #S9, RN revealed that (Patient #2) was found on the floor. It was noted at that time that the patient was awake and disoriented, and it was noted the patient was unable to follow commands. Documentation reflected "UNABLE TO FULLY ASSESS EXTREMITIES. NO FLACCIDITY NOTED WITH PASSIVE ROM. NO VERBAL RESPONSE" The patient's Glasgow Coma Scale reflected a total score of 9 which indicated the patient opened eyes spontaneously, had no verbal response and motor response was "WITHDRAWS FROM PAIN" .
Further review of the assessment reflected there were no family members present on 12/2/09 at 2330 and documentation reflected no family members were notified that the (Patient #2) was found on the floor.
Interview on 1/27/10 at 9:35 a.m. with #S7, RN, Acting Clinical Director of the Telemetry Unit, revealed she provided care to the patient on 12/2/09 on the 7:00 a.m. until 7:00 p.m. shift. #S7 confirmed the patient was high risk for falls, required safety checks every 2 hours and vital signs were to be completed every 4 hours on Patient #2. #S7, RN, further stated that a routine care statement was required on every patient on every shift. #S7, RN stated she gave the end of shift routine care report to #S8, LPN who provided care for on the 7:00 p.m to 7:00 a.m. shift beginning 12/2/09.
Interview with #S8, Licensed Practical Nurse (LPN), on 2/2/10 at 8:50 a.m. confirmed she provided care to (Patient #2) on 12/2/09 beginning at 7:00 p.m. #S8, LPN confirmed that documentation in the patient's medical record failed to reveal that #S8, LPN assessed the patient as high risk for falls and failed to reflect every 2 hour safety checks were completed. #S8, LPN confirmed there was no documentation of routine vital signs (every 4 hours) noted and no End of Shift routine care report was completed.
In further interview with #8, LPN, at that time revealed (Patient #2) was found on the floor at 2330 (11:30 p.m.) on 12/2/09. #S8, LPN, stated she and 3 other staff members immediately picked the patient up and put her in bed. #S8, LPN, stated she assessed (Patient #2) and the patient was gazing, not focusing and not following commands. #S8, stated she did vital signs and contacted #S4, M.D., Family Practice. #S8, LPN, stated she notified #S4, M.D., Family Practice of the "obvious neuro deficits" and #S4, M.D. ordered a stat CT of the brain without contrast, but did not order reassessment, frequent vital signs and/or neurological checks to be done on the patient. #S8, LPN revealed #S4, M.D. Family Practice stated to call her if there were any changes. #S8, LPN stated that she did not document anything about the "fall" nor did she document any reassessments or routine assessment of ( Patient #2) after the patient was placed back in the bed.

#S9, R.N., Telemetry Charge Nurse was interviewed on 02/03/09 at 11:08 a.m. #S9, R.N., Telemetry Charge Nurse reported that she observed the patient lying on the floor with her hands under her head in a comfortable position. #S9,R.N., Telemetry Charge Nurse revealed that she was the Charge Nurse on 12/02/09 from 7:00 p.m. to 7:00 a.m. and she assisted with getting the patient off of the floor and back into the bed. #S9, R.N., Telemetry Charge Nurse reported that an assessment was done after the patient was placed back in the bed. #S9, R.N., Telemetry Charge Nurse reported that she completed a Post Fall Assessment and assessed the patient as a 9 on the Glasgow Coma Scale.
#S9, R.N., Telemetry Charge Nurse stated the #S8, LPN gave report by telephone to #S4, M.D. Family Practice about the incident of finding the patient on the floor. #S9, R.N., Telemetry Charge Nurse reported that she overheard the phone conversation between #S8, LPN and #S4, M.D. but she did not hear #S8, LPN report the neurological deficits or the Glasgow Coma Scale of 9 to #S4, M.D. #S9, R.N., Telemetry Charge Nurse stated #S8, LPN continued to provide care for [Patient #2] and that #S8, LPN did not report any other changes in the patient's status for the rest of the shift so therefore she (#S9, R.N.) did not reassess (Patient #2).

Based on record review and interview, the governing body failed to ensure that the medical staff bylaws were followed as evidenced by the failure of a Neurologist to provide a consult within 24 hours at the status at which the patient was admitted (possible cardiovascular accident) and according to the medical staff bylaws. The Neurologist performed the consult approximately 40 hours after the consult was ordered and after the patient had experienced a subdural hematoma for 1 or 1 patient who required a Neurology consult in a total sample of 20 patients (#2). Findings:
The medical record of (Patient #2) was reviewed. Review of the medical record revealed (Patient #2) was a 77 y/o who reported to the Emergency Room (ER) on 12/01/09 at 1325 (1:25 p.m.) with a chief complaint of impaired speech. Documentation reflected the patient was alert and oriented to person, place and time, had a past medical history of hypertension and a surgical history of cardiac bypass. Review of the ER record dated 12/01/09 reflected (Patient #2) had a blood pressure reading of 229/104 and was placed on a Code Purple (Stroke Protocol). The patient was ordered and received Aspirin 325 mg, Plavix 300 mg and Coumadin 5 mg by mouth at 1550 (3:50 p.m.). A Computerized Tomography (CT) scan was ordered and completed as per the hospital's Stroke Protocol. The results were reviewed, and the report reflected that (Patient #2) had an old small left cerebellar Cerebral Vascular Accident (CVA) and an old medial right frontal small CVA. The impression reflected "Age related white matter changes and old CVA finding noted with no acute findings."
Review of the ER's record Clinical Impression for (Patient #2) reflected the patient was admitted to the hospital with non-hemorrhagic CVA (Stroke) versus Transient Ischemic Attack (TIA). Documentation of the ER record reflected #S2 Registered Nurse, Family Nurse Practitioner (RN, FNP) completed the history and physical assessment which was countersigned by #S3, Medical Doctor (MD), Emergency Medicine. Review of the ER's physician's orders reflected an order for a neurology consult.
Review of the Physician's On-Call list for December, 2009 reflected while (Patient #2) was in the ER on 12/1/09, there was no neurologist on-call for the Emergency Room.
(Patient #2) was admitted to the hospital's Telemetry unit on 12/01/09 under the care of #S4, M.D., Family Practice. Review of (Patient #2) physician's admit orders to the Telemetry Unit on 12/1/09 (untimed) reflected a continued request for a neurology consult.
Review of an assessment dated 12/2/09 at 1745 (5:45 p.m.) completed by #S7, RN revealed that on 12/2/09 at 1600(4:00 p.m.), #S6, Neurology was notified that #S4, M.D., Family Practice wanted a neurologist to see (Patient #2), no later than "today" (12/2/09). It was noted that #S6, M.D., Neurology, reported that he would have #S5, M.D., Neurology see (Patient #2), today.
Review of the hospital's Consultation Reports revealed a Neurology Consultation for (Patient #2) was completed on 12/3/09 at 11:00 a.m. by #S5, M.D., Neurology (approximately 40 hours after the order was originally written).
Review of physician's orders dated 12/03/09 at 11:00 a.m. reflected a neurosurgery consult "stat" was ordered by #S5,M.D., Neurology.
Interview with #S5, M.D., Neurology on 2/2/10 at 12:30 p.m. revealed he was on-call on 12/3/09 and he went to see (Patient #2). #S5, M.D., Neurology revealed, although he was not the neurologist on-call on 12/2/09, he attempted to see (Patient #2) on 12/2/09, because the neurologist on-call for 12/2/09 (#S6,M.D., Neurology) asked him (#S5,) to see the patient. #S5, M.D., Neurology stated he was given the wrong room number on 12/2/09 and he did not see (Patient #2).

Interview with #S6, M.D., Neurology, on 2/3/10 at 1:08 p.m. revealed he was the neurologist on-call on 12/2/09, and he asked #S5, M.D., Neurology to see Patient #2 for him (#S6) on 12/2/09. #S6, M.D., Neurology, stated (Patient #2) was not seen by a neurologist on 12/2/09.

Based on medical record review, review of policies/procedures and interviews the hospital failed to meet the Condition of Participation for Nursing Services as evidenced by:

1. Failing to ensure that the R.N. supervises and assigns each patient to nursing staff according to nursing needs of the patient as evidenced by a LPN continuing to provide care of a patient after the patient had fallen (12/2/09 at 11:30 p.m.) and exhibited a significant decline in neurological status form 14 to 9 on the Glasgow Coma Scale, as assessed by the R.N. The R.N. failed to ensure and supervise that the LPN assigned to the patient after the fall conducted and recorded on-going observations and vital signs of the patient for 7 1/2 hours. At 11:30 p.m. the patient's blood pressure was noted to be 121/66. When the patient was reassessed at 8 a.m. the next morning, the patient's blood pressure was 218/100; Glasgow Coma Scale had declined to 3; the heparin lock was not patent to receive intravenous push antihypertensive medication as ordered per physician; the patient had no voluntary responses and only involuntary movements and decorticate posturing was noted. The patient was immediately transferred to ICU. This was evident in 1 of 1 patients in a total sample of 20. (#2) (Cross reference to findings at A0392)

2. Failing to ensure that a R.N. notified a physician and family (or delegated this to another staff member) after a patient is assessed with a significant neurological decline after experiencing a fall. Upon admit on 12/01/09, the R.N. assessed Patient #2 as having a Glasgow Coma Scale of 15; however, after the patient fell on 12/02/09, the R.N. assessed the patient's Glasgow Coma Scale as 9, but there was no evidence the R.N. notified the physician of the significant decline in neurological status or that a family member was notified for 1 of 1 patient in a total sample of 20 patients. (#2). (Cross reference to findings at A0385)

3. Failing to ensure that a R.N. supervised the nursing care for each patient on a telemetry unit as evidenced by end of shift reports not being completed by the off-going nursing staff in order to ensure continuity of nursing care for 6 of 6 sampled patients in a total sample of 20. (#2, #12, #13, #14, #15, and #16). (Cross reference to findings at A0392)

Based on medical record review, policy/procedure review and interviews the hospital failed to ensure that each patient received an ongoing assessment of patient's needs for patients who were provided care by #S8, LPN. as evidenced by not accurately assessing a patient for high risk for falls for 1 of 1 patients (#2), not assessing end of shift standards of care and routine vital signs for 6 of 6 patients who were provided nursing care by #S8, LPN. (#2, #12, #13, #14, #15, and #16). Findings:

On the Telemetry Unit, (Patient #2) was assessed on 12/01/09 at 1736 (5:36 p.m.) as high risk for falls and interventions were initiated. The interventions included bed in low position, top 2 quarter rails in up position at all times, bed exit alarm on, wheels locked and call bell within reach. Documentation on the Admission assessment dated 12/1/09 reflected (Patient #2) was also instructed to call for help. Documentation reflected (Patient #2 was alert and oriented to person, place and time and was able to understand instructions at that time.
Review of an initial assessment completed on 12/1/09 at 1736 (5:36 p.m.) reflected (Patient #2) had a fall risk assessment completed and was assessed as high risk for falls. Review of the admission assessment comment reflected (Patient #2) was admitted for sudden onset of speech difficulty at home. It was noted that the patient was having trouble with making sentences but was oriented to person, place and time. It was also noted that the patient was able to move all extremities equally. Upper and lower limb movements were bilaterally strong with strong bilateral hand grasp. Patient #2's Glasgow Coma Scale was 15 which reflected the patient opened eyes spontaneously, was oriented and obeyed commands. Documentation reflected that the patient was ambulatory with the aid of a walker.
Review of an assessment completed on 12/1/09 at 2345 (11:45 p.m.) reflected Patient #2 remained at high risk for falls. Review of an assessment completed by #S7, RN on 12/2/09 at 0730 (7:30 a.m.) revealed (Patient #2) had bilateral weakness to upper and lower limbs with bilateral weak hand grasps. Patient #2's Glasgow Coma Scale reflected a total score of 14. The patient was noted to open eyes to sound, was oriented and obeyed commands. The patient was also noted to have bilateral full range of motion.
Review of a nursing assessment completed on 12/2/09 at 2000 (8:00 p.m.) completed by #S8, LPN reflected that (Patient #2) was oriented to person only. Further documentation reflected (Patient #2) had bilateral weakness to upper and lower limbs with bilateral weak hand grasps. There was no documentation to reflect a Glasgow Coma Scale was completed at the above time. The patient was noted to be unsteady. Documentation reflected the nurse failed to assess the patient as high risk for falls.
The following entry noted on the nurse's assessment dated 12/2/09 at 2330 (11:30 p.m.) completed by #S9, RN revealed that (Patient #2) was found on the floor. It was noted at that time that the patient was awake and disoriented, and it was noted the patient was unable to follow commands. Documentation reflected "UNABLE TO FULLY ASSESS EXTREMITIES. NO FLACCIDITY NOTED WITH PASSIVE ROM. NO VERBAL RESPONSE." The patient's Glasgow Coma Scale reflected a total score of 9 which indicated the patient opened eyes spontaneously, had no verbal response and motor response was "WITHDRAWS FROM PAIN" .
Further review of the assessment reflected there were no family members present and documentation reflected no family members were notified that the patient was found on the floor.

Review of the Hospital's Patient Assessment and Reassessment Policy #55, reviewed and revised 03/08 reflected that reassessment should be ongoing and may be triggered by key decision points, at intervals specified by the departments/ancillary disciplines directly involved in providing patient treatment and/or care. Review of the policy reflected a reassessment would be completed and documented when there was a significant change in the patient's condition/diagnoses, when there was a change in the level of care and/or when an untoward event placed the patient at risk for an adverse outcome.

Further review of the policy #55 reflected vital signs were to be assessed every 4 hours unless otherwise ordered by the physician or there was a change in the patient's condition.

Review of the Hospital's Fall Prevention Policy #166, reviewed and revised 12/08 reflected that when a patient experienced a fall, the patient would be assessed immediately for evidence of injury before moving the patient; the physician, family/legal representative and manager/nurse supervisor would be notified.

Review of (Patient #2) Nursing Assessment dated 12/02/09 at 2330 (11:30 p.m.) reflected that vital signs were taken at 2330 (11:30 p.m.) and were not assessed again until 12/03/09 at 0800 (8:00 a.m.) in which the patient's blood pressure (B/P) was noted to be 218/100. (Patient #2's) neurological deficits reflected the patient was unresponsive, bilateral pupils were dilated with sluggish reaction, upper and lower limb movements were absent and the patients total Glasgow Coma Scale Score had decreased to 3.
Interview on 1/27/10 at 9:35 a.m. with #S7, RN, Acting Clinical Director of the Telemetry Unit, revealed she provided care to the patient on 12/2/09 on the 7:00 a.m. until 7:00 p.m. shift. #S7, R.N. confirmed the patient was high risk for falls, required safety checks every 2 hours and vital signs were to be completed every 4 hours on Patient #2. #S7, RN, further stated that a routine care statement was required on every patient on every shift. #S7, RN stated she gave the end of shift routine care report to #S8, LPN who provided care for Patient #2 on the 7:00 p.m to 7:00 a.m. shift beginning 12/2/09.
Interview with #S8, LPN, on 2/2/10 at 8:50 a.m. confirmed she provided care to (Patient #2) on 12/2/09 beginning at 7:00 p.m. #S8, LPN confirmed that documentation in (Patient #2 's) medical record failed to reveal that #S8, LPN assessed the patient as high risk for falls and failed to reveal every 2 hour safety checks. #S8, LPN further confirmed there was no documentation of routine vital signs (every 4 hours) noted and no End of Shift routine care report was completed.
In further interview with #8, LPN, at that time revealed (Patient #2) was found on the floor at 2330 (11:30 p.m.) on 12/2/09. #S8, LPN, stated she and 3 other staff members immediately picked the patient up and put her in bed. #S8, LPN, stated she assessed (Patient #2) and the patient was gazing, not focusing and not following commands. #S8, stated she did vital signs and contacted #S4, M.D., Family Practice. #S8, LPN, stated she notified #S4, M.D., Family Practice of the "obvious neuro deficits" and #S4, M.D. ordered a stat CT of the brain without contrast, but did not order reassessment or frequent vital signs. #S8, LPN revealed #S4, M.D., Family Practice stated to call her if there were any changes. #S8, LPN stated that she did not document anything about the "fall" nor did she document any reassessments or routine assessment of (Patient #2) after the patient was placed back in the bed.

Based on medical record review and interviews the hospital failed to ensure that a Registered Nurse supervised nursing care for each patient by allowing a LPN to care for a patient who had been found on the floor and who had a significant change in condition for 1 of 1 patients with neurological changes out of a total of 20 sampled patients. (#2) Findings:
Review of a nursing assessment completed on 12/2/09 at 2000 (8:00 p.m.) completed by #S8, LPN reflected that (Patient #2) was oriented to person only. Further documentation reflected (Patient #2) had bilateral weakness to upper and lower limbs with bilateral weak hand grasps. There was no documentation to reflect a Glasgow Coma Scale was completed at the above time. The patient was noted to be unsteady. Documentation reflected the nurse failed to assess the patient as high risk for falls.
The following entry noted on the nurse's assessment dated 12/2/09 at 2330 (11:30 p.m.) completed by #S9, RN revealed that (Patient #2) was found on the floor. It was noted at that time that the patient was awake and disoriented, and it was noted the patient was unable to follow commands. Documentation reflected "UNABLE TO FULLY ASSESS EXTREMITIES. NO FLACCIDITY NOTED WITH PASSIVE ROM. NO VERBAL RESPONSE." The patient's Glasgow Coma Scale reflected a total score of 9 which indicated the patient opened eyes spontaneously, had no verbal response and motor response was "WITHDRAWS FROM PAIN " .
Further review of the assessment reflected there were no family members present on 12/02/09 at 2330 (11:30 p.m.) and documentation reflected no family members were notified that the (Patient #2) was found on the floor.
Interview on 1/27/10 at 9:35 a.m. with #S7, RN, Acting Clinical Director of the Telemetry Unit, revealed she provided care to the patient on 12/2/09 on the 7:00 a.m. until 7:00 p.m. shift. #S7 confirmed the patient was high risk for falls, required safety checks every 2 hours and vital signs were to be completed every 4 hours on Patient #2. #S7, RN, further stated that a routine care statement was required on every patient on every shift. #S7, RN stated she gave the end of shift routine care report to #S8, LPN who provided care for Patient #2 on the 7:00 p.m. to 7:00 a.m. shift beginning 12/2/09.
Interview with #S8, LPN, on 2/2/10 at 8:50 a.m. confirmed she provided care to (Patient #2) on 12/2/09 beginning at 7:00 p.m. #S8, LPN confirmed that documentation in (Patient #2 's) medical record failed to reveal that #S8, LPN assessed the patient as high risk for falls and failed to do every 2 hour safety checks. #S8, LPN further confirmed there was no documentation of routine vital signs (every 4 hours) noted and no End of Shift routine care report was completed.
In further interview with #8, LPN, at that time revealed (Patient #2) was found on the floor at 2330 (11:30 p.m.) on 12/2/09. #S8, LPN, stated she and 3 other staff members immediately picked the patient up and put her in bed. #S8, LPN, stated she assessed (Patient #2) and the patient was gazing, not focusing and not following commands. #S8, LPN stated she did vital signs and contacted #S4, M.D., Family Practice. #S8, LPN, stated she notified #S4, M.D., Family Practice of the "obvious neuro deficits" and #S4, M.D. ordered a stat CT of the brain without contrast, but did not order reassessment, frequent vital signs and/or neurological checks to be done.
#S8, LPN revealed #S4, M.D., Family Practice stated to call her if there were any changes. #S8, LPN stated that she did not document anything about the "fall" nor did she document any reassessments or routine assessment of ( Patient #2) after the patient was placed back in the bed.
Review of (Patient #2) Physicians Orders dated 12/02/09 at 2330 (11:30 p.m.) reflected a telephone order authenticated by #S8, LPN reflected an order for STAT CT Brain without contrast; Call #S4, M.D., Family Practice with changes and stat labs for CBC, CMP, Ammonia level, Blood Cultures and UA with C&S were ordered.
Interview with #S4, M.D., Family Practice on 02/02/10 at 2:00 p.m. reflected that she was made aware that the patient was found on the floor and disoriented. #S4, M.D., Family Practice stated that #S8, LPN did not notify her of the patient's neurological deficits or that the patient's Glasgow Coma Scale Score had decreased from 14 at 12/02/09 at 7:30 a.m. to 9 at 12/02/09 at 2330 (11:30 p.m.). #S4, M.D., Family Practice stated that the report she received by telephone was "unalarming" due to the lack of information she received about the patient's neurological status. Based on the information received #S4, M.D., Family Practice indicated that she assumed the patient had become disoriented and laid on the floor. #S4, M.D., Family Practice stated that based on the information she received from #S8, LPN, she thought the patient had signs of an infection but if she had been informed of the patient's change in neurological status then she would have given more aggressive orders pertaining to a neurological deficit.
#S9, R.N., Telemetry Charge Nurse was interviewed on 02/03/09 at 11:08 a.m. #S9, R.N., Telemetry Charge Nurse reported that she observed the patient lying on the floor with her hands under her head in a comfortable position. #S9, R.N., Telemetry Charge Nurse revealed that she was the Charge Nurse on 12/02/09 from 7:00 p.m. to 7:00 a.m. and she assisted with getting the patient off of the floor and back into the bed. #S9, R.N., Telemetry Charge Nurse reported that an assessment was done after the patient was placed back in the bed. #S9, R.N., Telemetry Charge Nurse reported that she completed a Post Fall Assessment and assessed the patient as a 9 on the Glasgow Coma Scale. #S9, R.N., Telemetry Charge Nurse stated the #S8, LPN gave report by phone to #S4, M.D. Family Practice about the incident of finding the patient on the floor. #S9, R.N., Telemetry Charge Nurse reported that she overheard the phone conversation between #S8, LPN and #S4, M.D. but did not hear #S8, LPN report the neurological deficits or the Glasgow Coma Scale of 9 to #S4, M.D. #S9, R.N., Telemetry Charge Nurse stated #S8, LPN continued to provide care for [Patient #2] and that #S8, LPN did not report any other changes in the patient's status for the rest of the shift so therefore she (#S9,R.N.) did not reassess (Patient #2).
Review of the hospital's R.N. Charge Nurse Job Description reflected that the Charge Nurse would assure the continuity of patient care was provided in the the highest quality, efficient, and cost-effective manner. Further review reflected the Charge Nurse would serve as a liaison between patients, families, physicians, nursing staff and other health care team members.

Review of the Hospital's Patient Assessment and Reassessment Policy #55, reviewed and revised 03/08 reflected that reassessment would be ongoing and may be triggered by key decision points and at intervals specified by the departments/ancillary disciplines directly involved in providing patient treatment and/or care. Review of the policy reflected a reassessment would be completed and documented when there was a significant change in the patient's condition/diagnoses, when there was a change in the level of care and/or when an untoward event placed the patient at risk for an adverse outcome.

Further review of the policy #55 reflected vital signs were to be assessed every 4 hours unless otherwise ordered by the physician or there was a change in the patient's condition.