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Facility Representatives were notified at 11:30 AM on 05/25/200 there was an Immediate Jeopardy to patient health and safety in that the facility failed to provide 24-hour nursing services furnished or supervised by a RN in that two of two patients (#1 and #2) intubated on ventilators in the Intensive Care Unit (ICU) were not provided an assessment of lung sounds, heart sounds and bowel sounds every two hours for twelve hours (7:00 PM - 7:00 AM) on 04/04/20-04/05/20. The failed practice did not ensure that the patients had not been extubated or that the endotracheal tubes were not dislodged. The failed practice had the potential to affect all patients in the ICU. See A-0395 for details.

Based on policy and procedure review, record review and interview, it was determined the facility failed to provide RN supervision and evaluation of nursing care in that two of two patients (#1 and #2) intubated on ventilators in the Intensive Care Unit (ICU) were not provided an assessment of lung sounds, heart sounds and bowel sounds every two hours for twelve hours (7:00 PM - 7:00 AM) on 04/04/20-04/05/20. The failed practice did not ensure that the patients had not been extubated or that the endotracheal tubes were not dislodged. The failed practice had the potential to affect all patients in the ICU. Findings follow:

A. Review of Policy titled, "Critical Care Admission, Discharge Criteria, and Assessment Guidelines," on 05/21/20 showed that all ICU patients will have a physical assessment completed every 2 (two) hours.
B. Record review on 05/20/20 showed Nurses Notes for Patient #1 on 04/04/20 at 7:00 PM by RN #1 stated patient was sedated on a ventilator and RN #1 was unable to assess lung sounds, heart sounds or bowel sounds due to Powered Air Purifying Respirator (PAPR) Mask. Assessment and Cares notes by RN #1 on 04/04/20 at 9:00 PM and 11:00 PM and on 04/05/20 at 1:00 AM, 3:00 AM and 5:00 AM showed respiratory, cardiovascular, and gastrointestinal assessments were unchanged from previous assessments.
C. Record review on 05/21/20 showed Nurses Notes for Patient #2 on 04/04/20 at 7:00 PM by RN #1 stated patient was sedated on a ventilator and RN #1 was unable to assess lung sounds, heart sounds or bowel sounds due to PAPR Mask. Assessment and Cares notes by RN #1 on 04/04/20 at 9:00 PM and 11:00 PM and on 04/05/20 at 1:00 AM, 3:00 AM and 5:00 AM showed respiratory, cardiovascular, and gastrointestinal assessments were unchanged from previous assessments.
D. In an interview with the Director of Nursing on 05/26/20 at 11:00 AM, the above findings were verified.