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Tag No.: A0395
Based on review of hospital policies, medical records and staff interview, it was determined the hospital failed to ensure nursing followed hospital policy related to reassessing patients in the emergency department (ED) triage area for seven (7) of ten (10) patients. This affected patients #1, 3, 4, 5, 6, 8 and 10. This has the potential to affect the quality of care provided and the safety of all patients receiving emergency care when patients are not reassessed for changes in health status or care needs.
Findings include:
1. Hospital policy titled "Triage", last revised 2/10/14, states in part: "The Triage Nurse collects information regarding the patient's chief complaint, obtains vital signs and determines if the patient's condition is Class I, II, III, IV, or V...Other functions of the Triage process include reassessment of patients triaged to the waiting room, identification of health care learning needs, etc." It further states, "Urgency rating is determined by the following elements: 1) degree to which the problem is life-threatening, 2) risk of short-term complications, 3) salvage ability, 4) clinical assessment of the patient, 5) availability of treatment, 6) algorithms, and 7) department protocols." Additionally, the policy defines Category III - Urgent level as, "Conditions which involve a significant risk of significant complications or disabilities, or impairment of bodily functions. Patient must be...re-assessed at least every hour to determine any change in triage level."
2. Review of the medical record for patient #1 revealed the patient was assessed by the Triage Nurse and was assigned a level three (3) triage category. The patient was in triage from 8:00 p.m. to 12:40 a.m. and was not reassessed by the nurse until 11:44 p.m. The patient left the ED at 12:40 a.m., without being medically screened.
3. Review of the medical record for patient #3 revealed the patient was assessed by the Triage Nurse and was assigned a level three (3) triage category. The patient was in triage from 7:45 p.m. to 11:10 p.m. and was not reassessed by the triage nurse. The patient left the ED at 11:10 p.m., without being medically screened.
4. Review of the medical record for patient #4 revealed the patient was assessed by the Triage Nurse and was assigned a level three (3) triage category. The patient was in triage from 7:23 p.m. to 9:22 p.m. and was not reassessed by the triage nurse. The patient left the ED at 9:22 p.m., without being medically screened.
5. Review of the medical record for patient #5 revealed the patient was assessed by the Triage Nurse and was assigned a level three (3) triage category. The patient was in triage from 7:35 p.m. to 12:15 a.m. and was not reassessed by the triage nurse. The patient left the ED at 12:15 a.m., without being medically screened.
6. Review of the medical record for patient #6 revealed the patient was assessed by the Triage Nurse and was assigned a level three (3) triage category. The patient was in triage from 12:28 p.m. to 2:30 p.m. and was not reassessed by the triage nurse. The patient was moved to a bed in the ED at 2:30 p.m. and was discharged home at 9:30 p.m.
7. Review of the medical record for patient #8 revealed the patient was assessed by the Triage Nurse and was assigned a level three (3) triage category. The patient was in triage from 8:34 p.m. to 11:15 p.m. and was not reassessed by the triage nurse. The patient was moved to a bed in the ED at 11:15 p.m. and was discharged home at 1:53 a.m.
8. Review of the medical record for patient #10 revealed the patient was assessed by the Triage Nurse and was assigned a level three (3) triage category. The patient was in triage from 5:13 p.m. to 12:46 a.m. and was not reassessed by the triage nurse. The patient left the ED at 12:46 a.m., without being medically screened.
9. The medical records for patients #1, 3, 4, 5, 6, 8 and 10 were reviewed with the Director of ED during an interview on 10/7/14 at 1:10 p.m. and he agreed with the findings.