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Based on review of clinical records and interview, it was determined the Facility failed to assure an Important Message from Medicare was provided in advance (48 hours) of a patient's discharge in three (#6, #7, #9) of 15 (#1-#15) clinical records. Failure to provide an Important Message from Medicare prior to a patient's discharge did not assure the patient understood their rights and was likely to affect all Medicare patients admitted to the facility. Findings follow:

A. Review of the clinical record for Patient #6 revealed admission date of 08/21/15 and discharge date 09/02/15. There was no evidence an Important Message from Medicare was included and signed for 08/31/15.

B. Review of the clinical record for Patient #7 revealed admission date of 08/19/15 and discharge date 08/30/15. There was no evidence an Important Message from Medicare was included and signed for 08/28/15.

C. Review of the clinical record for Patient #9 revealed admission date of 08/23/15 and discharge date 08/27/15. There was no evidence an Important Message from Medicare was included and signed for 08/25/15.

D. Findings listed as A-C were verified with the Quality Manager during record review 09/09/15 at 1230.

Based on review of clinical records, review of policies and procedures, review of Arkansas State Board of Nursing Scope of Practice and interview it was determined the Facility failed to assure patient assessments were performed by Registered Nurses in seven (#2, #4, #6, #8-#10 and #14) of 15 (#1-#15) clinical records. Failure to assure patient assessments were performed by Registered Nurses did not assure interventions were planned based on assessment findings. The failed practice was likely to affect all patients in the Facility. Findings follow:

A. Review of policy, "Patient Assessment-Reassessment" revealed Patient assessment/reassessment is provided by qualified, discipline specific health care providers within their respective scope of practice within the organizational setting.

B. Review of Arkansas State Board of Nursing Scope of Practice ACA 17-87-102(6)(A-E) revealed the Practice of Professional (Registered) Nursing: the delivery of health care services which require assessment, diagnosis, planning, intervention and evaluation fall within the professional nurse scope of practice.

C. Review of Arkansas State Board of Nursing Scope of Practice ACA 17-87-102(5) revealed the Practice of Practical Nursing: the delivery of health care services which are performed under the direction of the professional nurse, licensed physician, or licensed dentist, including observation, intervention and evaluation, fall within the LPN/LPTN (Licensed Practical Nurse/Licensed Practical Technical Nurse) scope of practice.

D. Review of the clinical record for Patient #2 revealed assessments on 09/05/15 at 0840, 09/06/15 at 0900, 09/07/15 at 0900 and 09/07/15 at 2100 were performed by an Licensed Practical Nurse (LPN). There was no evidence a Registered Nurse (RN) performed assessments on those dates and times.

E. Review of the clinical record for Patient #4 revealed assessments on 08/14/15 at 0900, 08/15/15 at 0815, 08/15/15 at 2312, 08/16/15 at 2228, 08/17/15 at 2100, 08/19/15 at 2350, 08/22/15 at 2351, 08/23/15 at 2100, 08/24/15 at 2236, 08/29/15 at 2019, 08/30/15 at 2100 and 08/31/15 at 2100 were performed by an LPN. There was no evidence an RN performed assessments on those dates and times.

F. Review of the clinical record for Patient #6 revealed an assessment on 08/24/15 at 2316 was performed by an LPN. There was no evidence an RN performed an assessment on that date and time.

G. Review of the clinical record for Patient #8 revealed assessments on 08/30/15 at 2225, 09/02/15 at 0900, 09/02/15 at 2002 and 09/03/15 at 2100 were performed by an LPN. There was no evidence an RN performed assessments on those dates and times.

H. Review of the clinical record for Patient #9 revealed assessments on 08/23/15 at 2100 and 08/25/15 at 0900 were performed by an LPN. There was no evidence an RN performed assessments on those dates and times.

I. Review of the clinical record for Patient #10 revealed assessments on 08/28/15 at 1905, 08/29/15 at 2400, 08/29/15 at 1600, 08/30/15 at 1930, 08/31/15 at 2400 and 08/31/15 at 0400 were performed by an LPN. There was no evidence an RN performed assessments on those dates and times.

J. Review of the clinical record for Patient #14 revealed assessments on 09/03/15 at 0826, 09/03/15 at 1200, 09/03/15 at 1600, 09/04/15 at 0928, 09/04/15 at 1200, 09/04/15 at 1600, 09/04/15 at 1930, 09/05/15 at 2400, 09/05/15 at 0400, 09/06/15 at 1920, 09/07/15 at 2400 and 09/07/15 at 0400 were performed by an LPN. There was no evidence an RN performed assessments on those dates and times.

K. Findings identified as A was verified with the Chief Quality Officer on 09/09/15 at 1115. Findings identified as D-J were verified with the Quality Manager during record review 09/09/15 at 1230.