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Based on record review and staff interview, it was determined that the facility did not ensure that the registered nurse assessed the patient for 1 of 4 ( #2) on the survey sample. The practice may cause a delay in treatment that may lead to potential adverse outcome.

Findings Include:

1. Patient #2 was admitted to the facility on 9/23/09 with a diagnoses of High Fever and suspect Sepsis. The medical history documented diagnosis of Chronic Obstructive Pulmonary Disease (COPD), NIDDM (Non-insulin dependent diabetic mellitus), Prostate Cancer, and radium implant in the prostate (9/9/09). The patient was admitted to the medical surgical floor. The nurses' notes on 9/25/09 documented that a physician ordered morphine on the PCA (Patient Controlled Analgesia) pump. On 9/27/09, the rapid response team was called at 10:45 p.m. as the patient was found less responsive with labored respirations and an increase in temperature of 103.3 F. The response team consisted of an Intensive Care Unit (ICU) registered nurse (RN), Emergency Room RN, and Respiratory Technician. The RN called the physician at 10:45 p.m. and verbal orders were given for Narcan 0.4mg, Lasix 40mg and decrease Intravenous Fluids (IV) rate from 125 to 30cc per hour, and labs were ordered for arterial blood gas(ABG) and chest x-ray. The respiratory notes on the rapid response sheet documented diminished and tight bilaterally with faint expiratory wheezes, and bilateral decreased lung fields. Patient was placed on 5 liters of oxygen per nasal cannula with 90 to 91% oxygen saturations (sats). The vital signs (V/S) were documented as taken at 10:45 p.m., 103.1F, pulse 119, respiration 30, blood pressure 110/51 and oxygen sats of 98%, and at 11:00 p.m. v/s were 103.3, pulse 129, respirations 34, and blood pressure 122/78. There was no documented evidence that vital signs were assessed just prior to Narcan being given. The only documentation of vital signs was at 10:10 p.m. that revealed a temperature of 103.1F, pulse 124, respirations 22, and blood pressure 116/55. Per physician order, the patient (9/27/09) was transferred to ICU.

According to the facility policy and procedure for assessment/reassessment for the medical surgical floor, an initial assessment is completed within 1 hour of admission and completed within 24 hours of admission. The reassessments are performed by the registered nurse based upon, but not limited to, a change in condition, response to treatment, care needs identified in the plan of care, and system status related to the medical diagnosis.

Based on record review and staff interview, the facility did not ensure that, in accordance with the patients' needs and the specialized qualifications and competencies of the nursing staff, 2 of 4 (#3 and #4) had current competencies on the PCA (Patient controlled Analgesia) pump.

Findings Include:


1. Four personnel files were reviewed for competencies regarding the PCA pump for administration of medication. Two of the nurses personnel files reviewed did not have current competencies for the PCA pump. One (#3) of the nurses reviewed had a competency 3/4/09, another nurse was 11/24/08, and 2005 (#4). All the nurses reviewed either worked on the medical surgical floor or progressive care unit. An interview was conducted on 8/2/10 at 3:45 p.m. with the Chief Nursing Officer and verified the nurses did not have current competencies regarding the use of the PCA pump. Additionally, the Chief Nursing Officer stated that the facility has annual fairs conducted so nurses can get competencies completed, however, none at this time were scheduled.