HospitalInspections.org

Based on interviews and document reviews the facility failed to ensure patient staffing assignments were made based on the patient's needs and the competence of the nursing staff. This failure resulted in patients receiving Continuous Renal Replacement Therapy (CRRT) from staff with no evidence of training or competency in the use of the equipment in 1 of 3 medical records reviewed (Patient #6).

Findings include:

1. The facility failed to ensure nursing personnel were trained, and had demonstrated competency, before independently managing and treating a patient requiring CRRT (Patient #6).

a. On 7/22/19 at 1:02 p.m. an interview was conducted with the Clinical Development Educator (Educator #1) for the Progressive and Intensive Care Units (PCU and ICU). Educator #1 stated CRRT was used to provide dialysis (the process of removing fluid and waste from the body when the kidneys no longer function independently) for patients who were medically unstable and was a process which could last from 24-72 hours in duration.

Educator #1 stated in order for a nurse to care for a patient undergoing CRRT they were required to complete an education module and pass a test, attend an in-service and complete one to two orientation shifts with another experienced nurse qualified to do CRRT. She further explained for a traveling nurse to do CRRT, they would need to be able to verbalize the process during orientation. Additionally, there was an outside company which managed competencies for traveling nurses and they would hold any certifications the nurses had.

b. An interview was conducted on 7/22/19 at 1:48 p.m. with Interim ICU Nursing Supervisor #2 (Supervisor #2). Supervisor #2 explained there could be different complications while a patient was undergoing CRRT including lowered blood pressure, too much fluid loss for the body to compensate for, infections within the lines of the equipment if not handled properly and ultimately cardiac arrest (when the heart stops beating). Supervisor #2 stated because of the hourly monitoring of the amount of fluid being taken out or replaced by CRRT and the high risk of complications, the patient was assigned a trained nurse with experience and was to be the only patient the nurse would be responsible for that day.

Supervisor #2 verified in order for a nurse to care for a patient receiving CRRT, nursing staff was required to take the education module and pass the associated test, attend the in-service class and complete one to two orientation shifts with a nurse previously deemed competent with CRRT.

c. An interview was conducted on 7/23/19 at 8:55 a.m. with Relief Charge Nurse #3 (RN #3). RN #3 stated one of his roles as charge nurse was to make nursing assignments for the next shift. He explained he would take into consideration the acuity of the patients as well as the skills and training of the oncoming nurses. RN #3 stated there was a reference book which identified the nurses who were competent in higher level skills such as CRRT which he could reference while making assignments.

RN #3 stated if he was unable to find evidence of competency for a particular nurse, he would talk to his supervisor or manager for further guidance. Furthermore, he explained traveling nurses competencies were not kept in the reference book and he would talk to his manager prior to making any assignments for traveling nurses.

d. Review of Patient #6's medical record revealed on 4/3/19 the patient was receiving CRRT treatment. The nurse identified caring for Patient #6 was a traveling nurse and was the only patient the nurse was assigned to for the shift. The facility was unable to provide any evidence the nurse was competent to care for a patient receiving CRRT.

Supervisor #2 stated the manager had contacted the nurse prior to the start of the shift, who verbalized he was able to do CRRT. Supervisor #2 stated the facility "took his word for it" because there was no other nurses trained in CRRT to care for the patient on that shift.