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Based on medical record review and interviews it was determined the registered nurse failed to supervise and evaluate care to ensure care was provided according to physician orders for three (#6, #7, #10) of 10 patient records sampled.

Findings included:

1. Patient #6 was admitted on 04/27/2016. Physician admission orders ordered telemetry. The patient was transferred from the emergency department to the nursing unit at 3:49 p.m. The documentation revealed the order for telemetry was acknowledged by the nurse at 4:10 p.m. No documentation was found indicating when the telemetry was initiated.

An interview with the director of the nursing unit on 05/03/2016 at 1:00 p.m. revealed a telemetry strip should have been ran and placed on the patient's chart on initiation of telemetry.

2. Patient #7 was admitted on 04/26/2016. Physician orders at 9:30 p.m. revealed an order for telemetry. The order was acknowledged by the nurse at 10:11 p.m. The documentation revealed the initiating telemetry strip was at 1:00 a.m. on 04/27/2016. No documentation was found indicating when the telemetry was initiated.

An interview with the director of the nursing unit on 05/03/2016 at 1:00 p.m. revealed a telemetry strip should have been ran and placed on patient's chart on initiation of telemetry.

3. Patient #10 was admitted on 04/27/2016. The review revealed admission orders to notify the physician if the oxygen saturation was less than 92 percent. A review of the nursing documentation revealed the patient's oxygen saturation was documented at 91 percent at 12:53 a.m. There was no documentation the patient care technician communicated the oxygen saturation level to the nurse. There was no nursing documentation showing the nurse was aware or physician notified of the 91 percent oxygen saturation level. There was no documentation of any nursing interventions. A physician order dated 04/28/2016 for incentive spirometry every one hour was documented on the physician orders The incentive spirometry was documented by respiratory therapy on April 30th and May 1st . There was no other documentation confirming every 1 hour incentive spirometry.

An interview with the director of the nursing unit and the director of risk management on 05/03/2016 at 9:50 a.m. confirmed there was no evidence of incentive spirometry, except as noted by respiratory therapy on 04/30/2016 and May 01/2016 was performed.