HospitalInspections.org

Based on interview and record review the hospital failed to ensure the hospitals's combined ICU/PCU unit (Intensive Care Unit/Progressive Care Unit) had an approved staffing matrix. The ICU staffing matrix indicated there should be 2 patients per 1 nurse. Assignment sheets were reviewed for dates 9/23/2020-10/01/2020 which reflected 2-12 hour shifts for each day. Seven shifts of 17 shifts reviewed, had 3 patients assigned to 1 nurse.

Findings included:

During an interview on 9/30/2020 at 10:00 AM with Personnel #2 she said nurse managers schedule the nurses for each unit. Charge nurses made daily assignments. Personnel #2 had met with Personnel #21 in September, 2020. They had gone over goals and staffing. A new matrix was developed for the combined PCU/ICU but had not been approved. A nurse council meeting was planned for October, 2020. Personnel #2 said she needed time to assess nursing since she was just hired in August, 2020.

During an interview on 10/01/2020 at 12:00 PM with Personnel #22 she said the ICU and the PCU were combined on June 5, 2020. There wasn't a matrix that was followed since the 2 units had combined. She said they had a guideline they followed, a nurse could only have 3 patients. The 3 patients could be a combination of ICU and PCU patients. Personnel #22 didn't know who created the guideline or where it was documented. There was no matrix for the combined ICU/PCU unit.

During an interview on 10/01/2020 at 2:00 PM with Personnel #5 she said having to care for more than 2 ICU patients was very stressful.

ICU Staffing assignment sheets were reviewed for dates 9/23/2020-10/01/2020. The ICU matrix for staffing indicated there should be 2 patients for 1 nurse. There was not an approved matrix for combined ICU/PCU (intensive care unit/progressive care unit) available.

Thursday 9/24/2020
Day Shift. Personnel #13-3 patients (3 PCU). Personnel #5-3 patients (2 PCU, 1 ICU).
Night Shift. Personnel #14-3 patients (3 PCU).

Friday 9/25/2020
Day Shift. Personnel #13-3 patients (3 PCU).
Night Shift. Personnel #15-3 patients (2 tele, 1 ICU).

Saturday 9/26/2020
Day Shift. Personnel #17-3 patients (2 tele, 1 PCU).
Night Shift. Personnel #18-3 patients (2 ICU, 1 PCU).

Monday 9/28/2020
Night Shift. Personnel #19-3 patients (2 PCU, 1 ICU).
Personnel #8-3 patients (2 ICU, 1 PCU).
Personnel #14-3 patients (3 PCU).

The hospital's Nurse Staffing/Staffing Effectiveness for Hospitals policy with a revision date of 2/21/2018 reflected, the hospital would "...comply with Federal and state laws and regulations regarding nurse staffing through the following: Adopting, implementing and enforcing a nurse staffing policy that outlines the number and skill mix of nurses recommended to meet the volume and acuity of patients served... Adopting, implementing and enforcing a nurse staffing plan based on the Patient Care Unit, shift, evidence related to patient care needs, and types of patients served..."