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Tag No.: A0131
Based on record review, policy review and staff interview, the facility failed to inform the patient representative of a significant change in the patient condition for one (#8) of 10 sampled patients.
Findings included:
The nursing and respiratory therapy documentation dated 9/27/15 at 9:31 p.m. indicated Patient #8 was transferred from the Progressive Care Unit (PCU) to the Intensive Care Unit (ICU) due to worsening of the respiratory status. A detailed review of the medical record with the Risk Manager and the Nurse Analyst failed to reveal any evidence the facility notified or attempted to notify the patient representative of the significant change in the patient's condition.
The Risk Manager confirmed the finding on 11/24/15 at 2:00 p.m.