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HCA FLORIDA TRINITY HOSPITAL
SUPERVISION OF CONTRACT STAFF
Tag No.: A0398
Based on facility policies, record reviews and staff interviews it was determined that the facility failed to follow the facility policies for continuous cardiac monitoring in one (#1) out of 7 sampled patients.
Findings included:
Review of the Policy and procedure title, "Cardiac Telemetry Monitoring", #ADMIN II.PC-T.005, effective 02/2023 ... Patient on cardiac telemetry will have their rhythm continuously monitored by a telemetry technician or nurse who is competent in cardiac rhythm interpretation ...The Nurse assumes responsibility for the initiation and management of cardiac monitoring ... Patients should be placed on telemetry as ordered by the provider ...Telemetry will be placed timely upon receipt of the providers order (not to exceed 30 minutes) ...
Review of the medical record for Patient #1 revealed that on 10/16/2022 at 1:48 PM she arrived to the Emergency Department with complaints of Chest pain radiating down the left and right arm with associated symptoms of nausea, numbness, tingling and vomiting. Patient # 1 had a prior history of a myocardial infarction (MI).
On 10/16/2022 at 1:49 PM the Registered Nurse (RN) triage Patient #1 with an acuity level of 2 / emergent and the ED doctor performed an MSE (Medical Screening Exam) and ordered continuous cardiac monitoring.
On 10/16/2022 at approximately 2:00 PM Patient #1 was placed back in the lobby without a cardiac telemetry monitor on.
Patient #1 electrocardiogram (EKG- detects heart problems and monitors the heart health) on 10/16/2022 at 1:50 PM resulted in PVC (premature ventricular contraction-abnormal heartbeats that begins in the 2 lower chambers of the heart), Lateral ischemia (reduces blood flow preventing heart muscle from receiving enough oxygen), atria enlarged bilateral, heart rate 82.
On 10/16/2023 5:01 PM Patient #1 moved from the lobby to ED bed #18.
On 10/16/2023 at 5:30 PM the Nurse placed the continuous cardiac monitor on Patient #1 which is 3 hours and 41 minutes after the order was placed by the MD.
On 10/16/2022 at 6:40 PM Patient #1 had another EKG interpretation of normal rate, normal sinus rhythm, lateral ischemia, and heart rate of 83.
On 10/16/2022 at 6:43 PM the ED Doctor consulted the on-call cardiologist to review of the EKG and labs it was confirmed that that Patient #1 had a NSTEMI (Non-ST- elevation myocardial infarction- A type of heart attack that usually happens when your heart's need for oxygen can't be met causing irreversible necrosis (death) of heart muscle) and ordered heparin (blood thinner) and nitroglycerin drip (for pain and blood pressure management), intravenous (IV) to be started, a cardiac catheterization with percutaneous Coronary intervention (non-surgical procedure used to treat the blockage in the coronary artery; opens up narrowed or blocked section of the artery, restoring blood flow to the heart) is scheduled in the mid-morning.
On 04/18/2023 at 11:44 AM an interview with Staff P, she confirmed the continuous cardiac monitor was ordered on 10/06/2023 at 1:49 PM and the staff did not place the cardiac monitor on the patient until 10/16/2023 at 5:30 PM and it should have been placed within 30 minutes per policy.
On 04/18/2023 at 12:02 PM an interview with the Vice President Quality & Risk Management and she confirmed that the cardiac monitor should have been placed within 30 minutes of the orders.
EMERGENCY SERVICES POLICIES
Tag No.: A1104
Based on facility policies, record reviews and staffs interview it was determined that the facility failed to follow the facility policy and procedure on reassessment of patients waiting in the Emergency Department (ED) lobby following the medical screening exam (MSE) one (#1) out of 7 sampled patients.
Findings included:
Policy and Procedures title, "Assessment and Reassessment", # ADMIN.II-PC-A.002, effective 06/30/2022 ... All patients entering the Emergency Room are triaged by an RN and assigned a priority, based upon their presenting symptoms and severity of illness. The priorities are categorized as follows:
Level 1 - Resuscitation- Patients who require immediate lifesaving interventions.
Level 2 - Emergent- Patients who are in high risk situations, confused, lethargic, and disoriented or in severe pain or distress ...
Patients are reassessed based on the triage priority ... Patients are reassessed in the waiting area based on triage guidelines and patients are re-categorized as appropriate ...
Reassessments after the initiation of the medical screening exam (MSE) are performed by RNs according to acuity level:
Level 1/Resuscitative will be performed continuously
Level 2/Emergent will be performed every 60 minutes ...
Review of the medical record for Patient #1 revealed that on 10/16/2022 at 1:48 PM she arrived to the Emergency Department with complaints of Chest pain radiating down the left and right arm with associated symptoms of nausea, numbness, tingling and vomiting. Patient # 1 had a prior history of a myocardial infarction (MI).
On 10/16/2022 at 1:49 PM the Registered Nurse (RN) triaged Patient #1 with an acuity level of 2/urgent and the ED doctor performed an MSE in which she ordered continuous cardiac monitor.
On 10/16/2022 at approximately 2:00 PM Patient #1 was placed back into the lobby.
On 10/16/2022 at 1:50 PM Patient #1's electrocardiogram (EKG- detects heart problems and monitor the heart health) resulted showing PVC (premature ventricular contraction-abnormal heartbeats that begins in the 2 lower chambers of the heart), Lateral ischemia (reduces blood flow preventing heart muscle from receiving enough oxygen), atria enlarged bilaterally, heart rate 82.
On 10/16/2023 5:01 PM Patient #1 moved from the lobby to ED bed #18.
Patient #1 was reassessed on 10/16/2023 at 5:26 PM which is 3 hours and 25 minutes after the initial assessment.
On 10/16/2023 at 5:30 PM the Nurse placed the continuous cardiac monitor on Patient #1 which is 3 hours and 41 minutes after the order placed by the MD.
On 10/16/2022 at 6:40 PM Patient #1 had another EKG interpretation of normal rate, Normal Sinus rhythm, lateral ischemia, and heart rate of 83.
On 10/16/2022 at 6:43 PM the ED Doctor consulted the on-call cardiologist and review of the EKG and labs confirmed that that Patient #1 had a NSTEMI (Non-ST- elevation myocardial infarction- A type of heart attack that usually happens when your heart's need for oxygen can't be met causing irreversible necrosis of heart muscle) and ordered heparin (blood thinner) and nitroglycerin drip intravenous (IV) to be started with a cardiac catheterization with Percutaneous Coronary intervention (non-surgical procedure used to treat the blockage in the coronary artery; opens up narrowed or blocked section of the artery, restoring blood flow to the heart) scheduled in mid- morning on 10/17/2022.
On 04/18/2023 at 11:44 AM an interview with Staff P confirmed the continuous cardiac monitor was ordered on 10/06/2023 at 1:49 PM and the staff did not place the cardiac monitor on the patient until 10/16/2023 at 5:30 PM and it should have been placed within 30 minutes. Upon further review of the medical record, she confirmed that the initial triage was completed on 10/16/2023 at 1:49 PM and no nursing reassessment was completed until 10/16/2023 at 5:26 PM, and that it should have been done every 60 minutes.
On 04/18/2023 at 12:02 PM an interview with the Vice President Quality & Risk Management was conducted in which she confirmed that the nurse did not reassess the patient every 60 minutes per policy. She also confirmed that the cardiac monitor should have been placed within 30 minutes of the orders.