HospitalInspections.org

Based on record review and interview, the hospital did not provide 1 of 10 patients (Patient #1) who filed a grievance on 5/9/15 with a written response as required.

Findings included:

The hospital received a grievance from Patient #1 on 5/9/15 via the hospital's website. His complaint was regarding quality of care issues during his emergency department and in-patient admissions on 5/8/15. There was no letter of response sent to Patient #1.

In an interview on 8/25/15 at 12:55 PM Personnel #6 was asked about Patient #1's grievance. She replied the complaint was filed on-line on 5/9/15 (Saturday). Personnel #6 was asked if a letter of response was sent. She replied no letter was sent.

Policy "Patient Grievance & Complaint..." revised 5/2015 required "Processing a Grievance: All formal and informal grievances will be investigated...1...will be entered into the on-line variance system...3. The patient...will receive written communication from the organization within 7 days of the receipt...When grievance...will not be completed within 7-day time frame; the patient...will be informed...that follow up will be provided in the form of written response within 30 days."

Based on record review and interview, the hospital's registered nurses (RNs) in 2 of 2 patient care areas (Emergency Department and Telemetry in-patient floor) did not supervise and evaluate the nursing care of Patient #1 who presented in the emergency department (ED) and subsequently was admitted as an in-patient in the telemetry floor on 5/8/15.

Findings included:

Patient #1 presented to the hospital's ED on 5/8/15 with a chief complaint of "chest pains." Physician's order at 4:45 PM was to initiate "Troponin-chest pain protocol." The protocol required a total of three blood draws at one hour apart. The first blood draw was at 5:10 PM. At 7:04 PM another Troponin blood draw was completed. There was no Troponin blood draw performed between 5:10 PM and 7:04 PM.

In an interview on 8/25/15 at 1:40 PM Personnel #4 was asked what the protocol was to initiate "Troponin-chest pain protocol." She stated the protocol required a total of three blood draws at one hour apart. She was asked to review the medical record (electronic and non-electronic) with the surveyor to determine the times that "Troponin" blood draw was performed. She confirmed the first draw was on 5/8/15 at 5:10 PM and the next one was at 7:04 PM. She confirmed there were 2 blood draws for Troponin and the second blood draw was "missed."

At 6:00 PM the ED "Disposition" reflected "unchanged, unstable, admit." At 6:08 PM, physician orders were electronically written which included "Admit to Observation Telemetry Monitoring Floor...Vital Signs per protocol...Frequency/Rate: continuous." At 7:13 PM an ED nurse noted that Patient #1 was "transferred to floor via wheelchair."

The first set of vital signs in the telemetry floor was at 8:12 PM, almost an hour after ED discharge. There were no nursing assessments and/or nurse's notes by a telemetry nurse.

In an interview on 8/25/15 at 2:00 PM and 4:00 PM Personnel #5 was asked to review the medical record (electronic and non-electronic) with the surveyor to determine what time the patient was admitted to the Telemetry floor and what time the patient was connected to a monitor. She stated she could not find the times since there was no documentation about it. She confirmed there were no nursing assessments and/or nurse's notes. She stated the documentation of the first set of vital signs was at 8:12 PM. Personnel #5 was asked if this was an acceptable practice to obtain the first set of vital signs an hour after admission. She replied that it was not. She stated the expectation was "15 minutes" after patient arrival.

Policy "Nursing Practice...Assessment: Initial/Admission" revised on 6/2015 required "Procedure: 1. Upon entering any patient care unit, each patient's physical, psychological...will be assessed by a RN (registered nurse) to determine immediate needs, appropriate assignment of care, and data collection...2...b. Vital signs completed by an authorized hospital employee... "