HospitalInspections.org

Based on record review and interview the facility failed to provide adequate numbers of respiratory therapists to provide respiratory care and services to ensure administration of medications in accordance with the physician's order in 1 (SP #1) of 4 sample patients (SP).


The findings include:


Record review showed on 05/24/19 at 2:11 PM, sample patient (SP) #1 was seen and examined by Pulmonology #1 (initial Consultation)- He wrote "SP#1 with Cystic Fibrosis (CF). The pulmonary consultant wrote in the progress note "it is very important that patient receives his treatments and medications on schedule".

Medication Administration Review showed SP#1 had the following respiratory medication orders: Sodium chloride 7% inhalation every 6 hours.

The record review showed that the (SP #1) patient did not received his Sodium Chloride 7% as order. On 5/26/19, the patient received only one dose out of four at 05:00 AM.

On 10/9/2019 at 12:00 PM, during an the interview, Respiratory Therapist #2 states today he is taking care of six patients on ventilators and administering nebulizer treatments. When SP#1 was hospitalized during May 2019, it was really "really busy" and the staffing was not optimal. Since then, the department has made "good" improvement in increasing the staffing levels.

Interview with Director of Respiratory Therapy on 10/08/19 at 1:33 PM, the Director stated that the department staffing is a "challenge" due to staff retirements. There is an ongoing effort to increase recruitment and the staffing situation is improving. At present there are 16 to 18 Respiratory Therapist during the day shift and 15 Therapist at night to cover the entire hospital. In the trauma intensive care unit, there will be assigned 2 or 3 therapist per shift. Regarding medication administration, the Director stated a Respiratory Therapist will reschedule a medication if the patient missed any nebulizer treatment and the therapist will document the administration of a medication in the patient's Medication Administration Record. If the department is short staff in any day, the respiratory therapist will triage to determine which patient have priority in care. If necessary, the supervisor will provide direct care to the patients.

Interview with the Director of Critical Care in the Trauma Intensive Care Unit (TICU)1 on 10/09/19 at 1:28 PM, states that the capacity of the Trauma Intensive Care Unit is 25 patients. The current unit census is 25 patients. States that there are 13 patients on ventilator and the unit is staff with two Respiratory Therapists. The Director also states that if needed, the RN (Registered Nurse) can trouble shoot if there is any problem with a ventilator. The Director reports that there is no issue with Respiratory Therapist not carrying out their duties.

On 10/9/2019 at 11:38 AM, interview with Respiratory Therapist #1, states that at present is responsible for six patients on ventilators and one patient that needs respiratory therapy treatments. States that the Respiratory Department staffing is "ok". As far as medication, if missing a medication, the procedure is to notify the pharmacy about the situation.

On 10/9/2019 at 11:50 AM - Interview Registered Nurse (RN#2), states that the Respiratory Therapist is an essential part of their team. There are times when they are short staff. When that happens, they must cover other units They accomplished their duties.