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Based on record review and interview the facility failed to ensure patient's received care in a safe setting for 3 (P[Patient] 5, P6, P10) out of 6 patients (P5-P7, and P10-P12) reviewed for receiving services at the hospital when staff failed to:
1. Monitor vital signs and pain for patient seeking care in the emergency department for P10.
2. Bathe P5 and P6.

These deficient practices could lead to patients not receiving the care they need at the hospital such as hygiene services and vital sign monitoring.

The findings are:

Facility failed to monitor patients

A. Record review of the facility's policy titled, "Emergency Department Nursing Guidelines for Care" dated 09/17/2024 on page 3 under "Vital Signs" it stated, "Vital Signs frequency is based on the ESI [Emergency Severity Index, system used to triage patients] score assigned, or more frequently as patient condition warrants. This includes patients in the lobby. 3.1.1. ESI 1: frequency based on the severity of patient's condition 3.1.2. ESI 2: every 1 - 2 hours 3.1.3. ESI 3: every 2 - 3 hours 3.1.4. ESI 4 and 5: every 3 - 4 hours 3.1.5. Within 30 minutes of discharge/transfer from the ED [Emergency Department]".

B. Record review of P10's electronic medical record for the visit date 08/12/2024 revealed the following:
1. Vital sign flowsheets dated 08/12/2024, indicated P10's vital signs were checked at 11:16 AM. Pain assessment with a rating of 0 (no pain) was charted at 11:16 AM and at 8:34 PM. The medical record contained only one set of vital signs and one pain assessment completed while patient was in the emergency department.

2. Medications administered on 08/12/2024 revealed that patient was given lorazepam (medication given for anxiety) 2 milligrams at 11:57 AM, fentanyl (medication given for pain) 25 micrograms at 11:53 AM, fentanyl 25 micrograms at 12:33 PM, and naloxone (medication given to reverse pain medication) 2 sprays at 1:00 PM.

3. Patient was transferred out of the emergency department at 6:50 PM and admitted to the hospital.

C. During an interview on 11/06/2024 at 3:30 PM with S (staff) 18, non-clinical, it was explained that vital signs are monitored regularly based on the patient's condition. S18 explained that pain assessments should be done before and after pain medications.

Facility failed to ensure patients were bathed:

D. Record review of the facility's policy titled, "Nursing Guidelines's for Care - Adult Medicine/Surgical" dated 04/29/2024 on page 3 under "Dependent Care Related Measures" stated, "Assistance with complete bath or shower is offered and documented in the patient's EMR [electronic medical record] at least once every 24 hours."

E. Record review of P5's medical record for the hospital stay from 08/06/2024 through 08/12/2024 in the daily care flowsheets, staff did not document that a bath or shower was provided.

F. Record review of P6's medical record for the hospital stay from 08/06/2024 through 08/12/2024 in the daily care flowsheets, staff did not document that a bath or shower was provided.

G. During an interview on 11/5/2024 at 3:00 PM S(Staff)5 confirmed there were no baths documented for P5 and P6.

Based on observation, record review, and interview the facility failed to ensure staff were following the hospital's policies and procedures to provide patients baths and monitoring patient's pain and vital signs while in the hospital for 5 (P[Patient] 5, P6, P10, P13, and P14) out of 8 patients (P5-P7, and P10-P14) reviewed for receiving services at the hospital. This deficient practice could lead to an increased risk for skin breakdown, increased infection rate, lack of basic hygiene and lack of monitoring for all admitted patient in the facility.

The findings are:

A. Record review of the facility's policy titled "Nursing Guidelines for Care" effective date 04/29/2024, under the heading "Hospitals," number 4. "Dependent Care Related Measures," section 4.1 and section 4.2 stated the following:
1. Section 4.1 "Assistance with complete bath of shower is offered and documented in the patient's EMR [electronic medical record] least once every 24 hours."
2. Section 4.2 "A partial bath is administered and/or offered as appropriate to the patient or situation (e.g. incontinence, semi-independent patient) and documented in the patient's EMRa lease once every 24 hours."

B. Refer to Tag A-144

C. During an observation on the adult inpatient unit on 11/05/24 at 1:52 pm, P13 laid in bed with uncombed hair and a hospital gown that appeared unclean.

D. During an observation on the adult inpatient unit on 11/05/24 at 2:07 pm, P14 laid in bed appearing disheveled with uncombed hair.

E. Record review of a bath log was found at the nurse's station on a clip board was noted not to have any patient showers or baths entered as completed for the day.

F. During an interview on 11/05/24 at 1:52 pm with P13, patient stated he/she had not received or had been offered a bath or shower for several days.

G. During an interview on 11/05/24 at 2:07 pm with P14, patient stated he/she had not been offered bath or shower for five days.

H. During an interview with S(staff)11, clinical on an adult inpatient unit on 11/05/24 at 1:17 pm, S11 stated that patients are offered a shower or bath every shift with documentation of this hygiene entered into the patient's EMR as well as documented on a bath log sheet which is kept at the nurses' station on a clip board.







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