HospitalInspections.org

Based on facility policy/procedure, review of medical records, review of personnel files, and staff interviews, the facility failed to ensure a Registered Nurse (RN) supervised and evaluated the care for each patient on an ongoing basis. Instead, the facility allowed patient care to be provided independently by Licensed Practical Nurses (LPN). Specifically, one LPN (#12) within the facility routinely provided care to patients without supervision, assistance, or collaboration with an RN, despite the facility's policy and procedure to do so. This failure created the potential for a negative patient outcome and did not ensure all patients were provided care by a Registered Nurse.

Findings:

1. Staff member #12, an LPN, routinely provided independent care, including physical assessments, to patients without oversight or evaluation by an RN.

a. Staff member #12's job description stated the following: "The LPN performs delegated duties consistent with his/her scope of practice and functions within the philosophy and overall plan of care delivery at NSMC."

b. The facility's policy titled Patient Assessment and Reassessment, issued 2/11, stated the following: "Reassessment must occur by an RN every shift or more frequently as indicated by the patient's condition or by physician order as otherwise defined in specific setting."

c. Review of sample medical record #3 revealed that, on 3/27/13 day shift, the patient was exclusively assessed and cared for by an LPN. No other record of an RN assessment of the patient or care during that shift was found.

d. An interview was conducted with the Medical Surgical Unit's charge nurse on 4/8/13 at approximately 9:15 a.m. When asked if any LPNs worked on the unit, the charge nurse stated one. When asked if the LPN was paired with an RN or had oversight by an RN, the charge nurse stated the LPN did not get paired with an RN. The charge nurse was asked who conducts the physical assessments of patients assigned to the LPN. S/he stated, "[S/he] does not do the initial [admission assessment and history] but does all those after that."

e. An interview with the Director of Nursing was conducted on 4/8/13 at approximately 11:00 a.m. When asked about the LPN conducting assessments, s/he stated LPNs could not give intravenous push medications or blood, but they could do all other care and assessments but the initial admission assessment.

Based on facility policy/procedure, review of medical records, review of personnel files, and staff interviews, the facility failed to ensure a Registered Nurse (RN) supervised and evaluated the care for each patient on an ongoing basis. Instead, the facility allowed patient care to be provided independently by Licensed Practical Nurses (LPN). Specifically, one LPN (#12) within the facility routinely provided care to patients without supervision, assistance, or collaboration with an RN, despite the facility's policy and procedure to do so. This failure created the potential for a negative patient outcome and did not ensure all patients were provided care by a Registered Nurse.

Findings:

1. Staff member #12, an LPN, routinely provided independent care, including physical assessments, to patients without oversight or evaluation by an RN.

a. Staff member #12's job description stated the following: "The LPN performs delegated duties consistent with his/her scope of practice and functions within the philosophy and overall plan of care delivery at NSMC."

b. The facility's policy titled Patient Assessment and Reassessment, issued 2/11, stated the following: "Reassessment must occur by an RN every shift or more frequently as indicated by the patient's condition or by physician order as otherwise defined in specific setting."

c. Review of sample medical record #3 revealed that, on 3/27/13 day shift, the patient was exclusively assessed and cared for by an LPN. No other record of an RN assessment of the patient or care during that shift was found.

d. An interview was conducted with the Medical Surgical Unit's charge nurse on 4/8/13 at approximately 9:15 a.m. When asked if any LPNs worked on the unit, the charge nurse stated one. When asked if the LPN was paired with an RN or had oversight by an RN, the charge nurse stated the LPN did not get paired with an RN. The charge nurse was asked who conducts the physical assessments of patients assigned to the LPN. S/he stated, "[S/he] does not do the initial [admission assessment and history] but does all those after that."

e. An interview with the Director of Nursing was conducted on 4/8/13 at approximately 11:00 a.m. When asked about the LPN conducting assessments, s/he stated LPNs could not give intravenous push medications or blood, but they could do all other care and assessments but the initial admission assessment.