HospitalInspections.org

Based on findings from document review, medical record (MR) review and interview, the facility did not ensure that all patients received care according to its policies and procedure (P&P) and current standards of practice related to vital sign monitoring for 1 of 11 patients, Patient #1.

Findings include:

-- The hospital P&P titled "Intravenous Thrombolytic Therapy for Acute Ischemic Stroke- TPA (tissue plasminogen activator)," last revised 2/2014, indicated that nursing staff should obtain initial vital signs (blood pressure (BP), pulse (P), respirations (R), oxygen saturation (O2 Sat) initially at the beginning of a TPA infusion and then at least every 15 minutes for 1 hour duration, then every 30 minutes for 6 hour duration and then hourly for 16 hours.

-- Review of Patient #1's MR revealed that the patient presented to the emergency department (ED) on 2/27/16 with chief complaint of acute mental status change. At 20:36 (time of triage) vital signs were obtained: BP 167/76, P 77, R 22, O2 Sat 96 %. A hospital stroke response was activated. Patient A underwent diagnostic testing which included CT angiogram (CTA) Head which showed a large ischemic area in the left parietal lobe consistent with distal middle cerebral artery (MCA) occlusion. At 21:41, Staff A ordered Alteplase (TPA) 6.6 mg intravenously (IV) bolus once followed by 59.1 mg IV infusion over 1 hour. At 22:02 Staff B documented administration of Alteplase bolus (6.6 mg) and at 22:07, initiation of Alteplase 59.1 mg infusion over 1 hour. At 23:03, Patient #1's vital signs were: BP 145/73, P 72, R 16, O2 Sat 97%. Patient #1 remained in the ED until 00:30 on 2/28/16 and was then transported to the intensive care unit. There is no documentation in the MR indicating that Patient #1's vital signs were obtained every 15 minutes during the TPA infusion and every 30 minutes thereafter while in the ED, per hospital P&P.

--During interview of Staff C on 5/5/16 at 14:30, the above finding was acknowledged.