HospitalInspections.org

Based on medical record review, policy review and staff interviews, the facility failed to follow their policy on continual visual remote monitoring to ensure the patients' privacy rights were protected. This affected two (Patient #6 and #8) of two patients' reviewed with visual remote monitoring. The sample size was 11. The current census was 184.

Findings include:


Review of the facility's policy on Continual Visual Remote Monitoring for Patient Safety using Tele-sitters revealed tele-monitoring was a nursing intervention to ensure patient safety for patients at high risk for falls, confusion and impaired mobility. The procedure revealed a physician's order was not required to initiate the continuous visual remote monitoring (CVRM) but the nurse was to communicate with the ordering provider the availability of the CVRM system and obtain agreement to utilize the telesitter in place of an ordered one on one sitter. This agreement was to be documented in the progress notes. The registered nurse (RN) was to assess the patient for appropriateness of the CVRM and document the reason for the use in the medical record. The RN was to document notification of patient and family that CVRM was implemented for patient safety and document education of the patient and family in the patient's medical record. The RN was to reassess the patient every shift for the need of the CVRM. Under III Patient Teaching of the policy, the patient and family were to be educated on the CVRM and the education will be documented on the patient education sheet. The patient had the right to refuse the use of remote visual monitoring.

1. Review of the medical record for Patient #6 revealed the patient was admitted to the facility on 11/14/15. During Patient #6's stay, he/she was treated for diagnoses including chronic respiratory failure, pneumonia and gastrointestinal bleeding. Review of the nurses notes, on 11/19/15 at 7:00 PM, revealed Patient #6 "appears to be having a seizure". The note revealed the patient was lifted into bed and an emergency code was called to summon a physician to the bedside. The note at 8:30 PM, written by a student nurse, revealed the patient was very drowsy after the seizure. The note also revealed the bed alarm was on and Avasys (CVRM) was in room to monitor post seizure activity. The note at 9:45 PM, written by a registered nurse (RN), revealed the RN agreed with the student's assessment of the patient and the patient was at a fall risk at this time due to recent seizure. Review of the Telesitter Visual Monitoring Log revealed Patient #6 was monitored from 11/19/15 at 7:00 PM through 11/22/15 at 3:00 PM, when Patient #6 was discharged

Further review of the medical record for Patient #6 revealed no evidence the patient and family was notified the CVRM was being used and tele-sitters were observing the patient from a remote location. There was also no documentation the patient and family was educated on the use of CVRM and was given a copy of the CVRM educational materials. There was no documentation that reassessments were done every shift by the RN of the need to continue remote visual tele-monitoring.

2. Review of the medical record for Patient #8 revealed the patient was being treated for the diagnoses of gastrointestinal bleeding, acute renal failure, anemia, rectal bleeding and dehydration. Review of the nurses notes, dated 11/22/15 at 11:00 PM, revealed the robo-sitter is in place and the one on one sitter is off to another patient. There was no assessment of Patient #8 to determine if Patient #8 met the criteria for use of CVRM. There was no documentation the patient and family was notified and educated on the use of the CVRM. There was also no evidence the physician was notified and agreed with the use of CVRM for Patient #8, in place of the one on one sitter observation.

On 11/25/15 at 11:00 AM, Staff A confirmed the above findings.