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709 NORTH LINCOLN AVENUE

JEROME, ID 83338

No Description Available

Tag No.: C0291

Based on document review and staff interview, it was determined the CAH failed to ensure the list of contracted services included a description of the nature and scope of the services provided for 56 of 56 contracts (#1-56) that were included on a list of contracted services. This resulted in incomplete information. Findings include:

A list of contracted services, "Report 2019 AME System Contract Number," included a list of 56 names of contracted services. It did not include a description of the nature and scope of the services provided.

The Accreditation RN was interviewed on 2/07/19 at 12:15 PM. She confirmed the CAH did not maintain a list of contracted services that included a description of the nature and scope of services.

The CAH's list of contracted services did not describe the nature and scope of the services provided.

No Description Available

Tag No.: C0298

Based on policy review, medical record review, and staff interview, it was determined the CAH failed to ensure nursing care plans were sufficiently developed and individualized for 4 of 7 medical inpatients (#3, #6, #7, and #8) and 1 of 3 labor and delivery inpatients (Patient #11) whose medical records were reviewed. This had the potential to impact quality and coordination of patient care. Findings include:

Surveyors requested a policy that addressed nursing care plans. Policy PE016 SLHS, "Nursing Assessment," dated 10/31/18, was provided. A section of the policy addressed care plans:

"An individualized plan-of-care will be formulated as soon as possible upon admission and updated based on ongoing assessment and patient needs.

...The Plan of care will include goals and interventions established in collaboration with the patient, family/significant other/guardian, and care providers.

...The RN will review and revise the plan as warranted in collaboration with the other disciplines."

Plans of care were not sufficiently developed or individualized to include relevant goals and/or interventions. Examples include:

1. Patient #6 was an 80 year old male admitted to the CAH through the ED on 3/09/18 and transferred to inpatient hospice care on 3/12/18. His primary diagnosis was sepsis. Additional diagnoses included pneumonia, respiratory failure, hypertensive heart disease, CHF, and COPD.

Patient #6's nursing care plan addressed fall risk, skin care, and comfort care. It did not address goals and interventions related to cardiopulmonary status, such as monitoring heart and lungs, weights, oxygen saturation, response to medication and oxygen, and relevant education to patient or caregivers.

The Assistant Nurse Manager was interviewed on 2/07/19 at 9:40 AM. She reviewed Patient #6's medical record and confirmed the nursing care plan did not address cardio-respiratory status.

Patient #6's nursing care plan was not sufficiently developed or individualized to address goals and interventions related to his cardio-respiratory status.

2. Patient #3 was an 11 year old male admitted to the CAH through the ED on 1/03/19 and transferred to an acute care hospital on 1/04/19. His diagnoses included influenza, pneumonia, and acute respiratory failure.

Patient #3's nursing care plan addressed fall risk and comfort. It included respiratory goals without corresponding respiratory interventions, such as oxygen delivery and assessment of oxygen saturation levels, lung sounds, use of accessory muscles, shortness of breath, response to medications (such as nebulizer treatment), reporting parameters, or relevant education to patient and caregivers.

Physician orders, dated 1/03/19, indicated Patient #3 was on contact isolation precautions and droplet isolation precautions. These precautions were not addressed in his nursing care plan.

The Assistant Nurse Manager was interviewed on 2/07/19 at 8:40 AM. She reviewed Patient #3's medical record and confirmed there were no interventions listed in the written nursing care plan that addressed respiratory interventions or isolation precautions.

Patient #3 nursing care plan was not sufficiently developed or individualized to address interventions related to his respiratory status or isolation status.

3. Patient #7 was a 77 year old female admitted to the CAH through the ED on 11/20/18, and transferred to another hospital via ambulance on 11/21/18. She arrived at the ED with shortness of breath and a diagnosis of asthma exacerbation and acute respiratory distress syndrome.

Patient #7's nursing care plan addressed fall risk, a skin plan, and comfort. The care plan included respiratory goals without corresponding respiratory related interventions, such as monitoring of lung sounds, respiratory effort, oxygen usage, oxygen saturation levels, response to medications, or relevant education to patient or her representative.

The Assistant Nurse Manager was interviewed on 2/07/19 at 9:30 AM. She reviewed Patient #7's medical record and confirmed there were no interventions listed related to Patient #7's respiratory status.

Patient #7's nursing care plan was not sufficiently developed or individualized to address interventions related to her respiratory status.

4. Patient #8 was a 64 year old male admitted to the CAH through the ED on 10/23/18 and discharged on 10/26/18. His chief complaint was hematuria. His primary diagnosis was sepsis due to urinary tract infection. Additional diagnoses included atrial fibrillation, hypertensive chronic kidney disease, and Type 2 diabetes mellitus.

Patient #8's nursing care plan addressed fall risk, a skin plan, and comfort. The care plan did not include goals or interventions related to sepsis, urinary status, atrial fibrillation or diabetes, such as assessment of cardiac rhythm and rate, blood glucose, urinary symptoms, sepsis symptoms, response to medications, or relevant education to patient or representative.

The Assistant Nurse Manager was interviewed on 2/07/19 at 9:38 AM. She reviewed Patient #8's medical record and confirmed the nursing care plan did not address sepsis, urinary tract infection, atrial fibrillation or diabetes mellitus.

Patient #8's nursing care plan was not sufficiently developed or individualized to address goals and interventions related to sepsis, urinary tract infection, atrial fibrillation, or diabetes mellitus.


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5. Patient #11 was a 35 year old female admitted to the CAH on 2/01/19 for induction of labor. Additional diagnoses included gestational diabetes and gestational hypertension.

Patient #11's nursing care plan addressed pain management, cardiopulmonary goals, fall risk, and comfort care. It did not address goals and interventions related to gestational diabetes such as blood sugar monitoring, insulin administration, nutrition, and relevant education for Patient #11.

The Assistant Nursing Manager was interviewed on 2/07/19 at 1:45 PM. She reviewed Patient #11's medical record and confirmed the nursing care plan did not address gestational diabetes.

Patient #11's nursing care plan was not sufficiently developed and individualized to address her gestational diabetes.

No Description Available

Tag No.: C1001

Based on review of patient rights information and staff interview, it was determined the CAH failed to ensure patients (or support persons, when appropriate) were informed of the right to receive visitors whom they designated, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and their rights to withdraw or deny such consent at any time. This had the potential to interfere with the exercise of visitation rights of all patients who received incomplete rights information. Findings include:

A patient pamphlet, titled "Patient Rights and Responsibilities," dated 2018, addressed visitation rights. The pamphlet stated:

"You have the right to designate an individual for the following categories:
- Patient Representative
- Support Person"

The pamphlet did not inform patients of the right to receive the visitors whom he or she designated, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or friend, and the right to withdraw or deny such consent at any time.

The Accreditation RN was interviewed on 2/07/19 at 11:30 AM. She confirmed the information in the pamphlet was the extent of information provided to patients related to visitation rights.

The CAH did not specifically inform each patient (or support person, where appropriate) of the right, subject to his or her consent, to receive the visitors whom he or she designates, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and his or her right to withdraw or deny such consent at any time.