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Based on medical record review and staff interviews the facility did not provide nursing care to meet the needs of all patients in that physician orders were not carried out for one of five patients reviewed (Patient #2).

Findings included:

Review of the medical record of Patient #2 revealed that the patient was admitted to the facility on 9-16-17, at 07:14 a.m. from the Emergency Department after falling and hitting his head without loss of consciousness, questionable syncope. The patient had a cardiac pacemaker. The History and Physical, done 9-15-17, at 13:30, revealed that Patient #1 had a past medical history of hypertension, hyperlipidemia, sick sinus syndrome status post pacemaker, and cardiomyopathy with an AICD (automatic implantable cardiac defibrillator). An EKG on 9/15/17 revealed electronic ventricular pacemaker with a heart rate of 70 and no acute ST-T wave changes. The medical plan included doing an echocardiogram and interrogating the pacemaker. The Cardiology Consult Note, 9-15-17, at 14:14, revealed a recommendation to obtain AICD interrogation. An order for this was observed entered on 9-15-17, at 13:55. Further review of a Progress Note, dated 9-20-17, at 15:00, found that the AICD interrogation was done by the Bio-scientific Tech. This revealed a 5 day gap from entry of the order to completion of the order. Interview with Nurse A on 8-22-18, at 4:40 pm revealed that the ordering process is for the patient's nurse to call the main biotech phone number for the tech to be paged. Expected return call is within 1 hour. This information is given in the hand-off report for follow-up by Nursing. Interview with Nurse B on 8-22-18 at 4:00 pm revealed that often the provider contacts the tech directly to inform of need for pacer interrogation or sometimes the Unit Secretary calls the tech. After review of the record by the Director of Quality/Patient Safety and interview on 8-22-18, at 4:15 pm, it was determined that it could not determined if follow-up by Nursing on the completion of the order happened. The reason for the delay is unknown.