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Based on observations, interviews and records reviewed, conditional non-compliance related to unsafe conditions existing for the Special Care Nursery patients was observed on 4/15/15. Immediate measures to remediate the unsafe conditions were completed by the Hospital at the time of survey.

See A-0142

Based on observations, interviews and records reviewed the Hospital failed to ensure a safe environment of care for eight of eight Special Care Nursery (SCN) babies (Patient's #1 through #8).

The Director of Maternal/Child Services Special Care Nursery (SCN) was interviewed at 9:30 A.M. on 4/15/15. The Director of Maternal/Child Services Special Care Nursery said babies were relocated on 4/8/15 from the open one room nursery model and placed into single private rooms in the Birthing Center. The Director of Maternal/Child Services said this was part of a month long trial of a family centered model that supposedly improved outcomes and decreased the length of the hospital stay for the special care nursery baby. The Director of Maternal/Child Services Special Care Nursery said the census of Special Care Nursery babies was 8 on 4/15/15.

On 4/15/15 at 9:45 A.M. the Surveyor observed Room 278 which contained two special care babies in incubators. Room 278 was located directly off a common hallway accessible to all staff, patients and visitors on the Birthing Center. The Surveyor observed the central monitor (a remote telemetry unit designed to provide constant monitoring of a newborn's heart and respiratory rate) directly outside of Room 278. The central monitor station was used to monitor babies that were not in direct view of those personnel accountable for their care and safety. The central monitor was not easily visible to the Surveyor unless she was standing in the doorway and the audible alarm was not distinct nor could the alarm be easily recognized above the normal noise level of the Unit.

The Surveyor interviewed SCN Registered Nurse #3 at 11:10 A.M. on 4/15/15. Registered Nurse #3 said she was assigned two special care babies. Registered Nurse #3 said her assigned babies were in Room 277 and Room 282. SCN Registered Nurse #3 said this assignment prohibited direct observation at all times of her assigned babies. The Surveyor stood in the doorway of Room 277 and was unable to observe or monitor the entrance into Room 282 that was located up the corridor and around a corner, approximately thirty feet from Room 277.

The Surveyor interviewed the Neonatologist covering the Special Care Unit at 10:00 A.M. on 4/15/15. The Neonatologist said this model for a Special Care Nursery was innovative and was practiced in Canada.

SCN Registered Nurse #1 was interviewed at 10:30 A.M. on 4/15/15. SCN Registered Nurse #1 said there were discussions leading up to this change and she knew the new model was to be trialled. SCN Registered Nurse #1 said the staffing numbers were the same as when the SCN babies were in the open nursery, however, she was concerned because of the decrease in visibility of her assigned babies. SCN Registered Nurse #1 said she now felt isolated and had written her concerns to her Manager.

SCN Registered Nurse #2 was interviewed at 10:55 A.M. on 4/15/15 said she was concerned for the safety of her patients. SCN Registered Nurse #2 said she could not consistently visualize and monitor her babies as before. SCN Registered Nurse #2 said she had concerns about being able to hear the monitor alarms. SCN Registered Nurse #2 said there were meetings held prior to the rollout of this model but now she did not feel safe.

SCN Registered Nurse #3 said months ago she had heard about this concept but she thought there would be some renovations to the unit before it happened. SCN Registered Nurse #3 said her assignment today was split between two rooms without any visibility between the rooms.

The Director of Maternal/Child Services said there were no provisions to monitor the temperature and humidity of the private rooms occupied by special care nursery babies as required by standards of care.

The Director of Maternal/Child Services said it was possible for an unrelated couplet to share the same private room and parents visiting one baby would not necessarily be supervised during the visit.

The Director of Maternal/Child Services said there was a staff meeting planned for the following day to review and answer staff concerns. The Director of Maternal/Child Services said staff were asked to submit any concerns in writing for discussion at this meeting.

The Manager of Special Care Nursery provided the Surveyor with the written staff concerns at 1:50 P.M. on 4/15/15 that were scheduled to be discussed. The SCN list of thirty-seven questions and concerns included adult visitors found in a SCN private room "looking at the baby" as there was no barrier to prevent entry, concerns about leaving the SCN infant alone as some conditions are not immediately represented on a monitor (i.e. seizure or chocking), visibility of central monitors, assignments located far apart for safe monitoring of the babies, and the difficulty of covering another nurses assignment during meals and breaks.

The Director of Maternal/Child Services said preparation meetings for this trial were held internally and did not include consultation or waivers from any regulatory agency.

The Surveyor met with the Chief Financial Officer, the Vice President of Quality, the Director of Maternal/Child Services, and the Manager of Special Care Nursery at 3:45 P.M. on 4/15/15. The team suggested that in order to provide a safe environment of care the eight Special Care Nursery babies would be returned to the Special Care Nursery immediately.