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Based upon record review and interview, the facility failed to ensure that the Initial telemetry strips were recorded for six (Sampled Patients( SP) #1, # 4, #5, #8, #10 & #11) of ten patients upon placement of the cardiac monitor, and vital signs assessed for 2 of 10 sampled patients SP#1 and # 10.

The findings include:

1. Review of the facility's policy titled, "Continuous Cardiac Monitoring (Telemetry)," revised on 08/13, noted the following: to obtain a physician order for cardiac monitoring, to attach appropriate lead wires from telemetry unit to electrodes. To then notify the telemetry technician that the patient is attached to the monitor. To Record a rhythm strip a minimum of 6 seconds in length and assess for rate, rhythm, PR interval, QRS width, QT interval. The rhythm strip is assessed by the telemetry technician, and validated by an RN (Registered Nurse).
Review of Sampled Patient (SP)#1 Face -Sheet showed that the patient was admitted to the facility on 08/11/14 at 7:50PM. Physician Orders on 08/11/14 at 10:21PM showed an order received for telemetry cardiac monitoring. Review of telemetry strips did not show that an initial telemetry strip was printed. The first rhythm strip was printed on 08/11/14 at 11:13PM, at shift change.


Review of SP#4 medical records showed that the patient was admitted to the facility on 08/20/14 at 7:52 PM. Physician Orders 08/20/14 at 8:53 PM showed an order for Telemetry Cardiac monitoring for 24 hours monitoring. Review of telemetry strips did not show that an initial telemetry strip was printed. Review of telemetry strips showed the first recorded rhythm was on 08/20/14 at 11:18 PM, at shift change.

Review of SP#5 medical record showed that the patient was admitted to the facility on 7/15/14 fat 6:30 PM. Physician Orders 07/15/14 at 7:14 PM showed an order for Telemetry Cardiac monitoring for 72 hours monitoring. Review of telemetry strips did not show that an initial telemetry strip was printed. Review of telemetry strips showed the first recorded rhythm was on 07/15/14 at 11:18 PM, at shift change.


Review of SP# 8 medical records showed that the patient was admitted to the facility on 09/03/14 at 5:55 PM. Physician Orders 09/03/14 at 7:42 PM showed an order for Telemetry Cardiac monitoring for 72 hours monitoring. Review of telemetry strips did not show that an initial telemetry strip was printed. Review of telemetry strips showed the first recorded rhythm was on 09/03/14 at 11:15 PM, at shift change.

Review of SP#10 medical record showed that the patient was admitted to the facility on 8/29/14 at 9:50 PM. Physician Orders on 8/29/14 at 10:32 pm an order for Telemetry Cardiac monitoring for 72 hours monitoring. Review of telemetry strips did not show that an initial telemetry strip was printed. Review of telemetry strips showed the first recorded rhythm was on 08/30/14 at 12:27 AM, after shift change.

Review of SP#11 medical record showed that the patient was admitted to the facility on 09/02/14 at 6:44 PM. Physician Orders on 09/02/14 at 8:21 PM showed an order for Telemetry Cardiac monitoring for 72 hours monitoring. Review of telemetry strips did not show that an initial telemetry strip was printed. Review of telemetry strips showed the first recorded rhythm was on 09/02/14 at 11:20 PM, at shift change.

On 09/09/14 at 10:41 AM, the Nurse Manager stated, "there should be an initial first strip."
On 09/08/14 at 3:40pm, Staff J, Monitor Technician, stated, that we print strips for patients on tele (telemetry) when the patients are put on the tele for the first time.




2. Review of SP#1 Face -Sheet showed that the patient was admitted to the facility on 08/11/14 at 7:50PM. Physician Orders on 09/03/14 at 1:11PM showed an order received for telemetry cardiac monitoring for 72 hours. The Vital Signs Flow Sheet did not show vital signs on 09/04/14 at 12:00PM.

Review of SP#10 medical record showed that the patient was admitted to the facility on 8/29/14 at 9:50PM. Physician Orders on 09/01/14 at 4:34PM showed an order for Telemetry Cardiac monitoring for 72 hours monitoring. Review of Vital sign Flow sheet did not show any documented vital signs on 09/04/14 at 12PM.

09/08/14 at 12:22PM, Staff G, Registered Nurse, stated, " we do vital signs for patients on tele every four hours."