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Based on observation and interview, it was determined that the facility failed to ensure that equipment was available in case of an emergency.

Findings were:

During a tour of the facility's emergency room (ER) on 12/8/2010 at 2:30 p.m. with the ER Director (employee #22), observations revealed that three (3) of three (3) rooms observed did not have an emergency call system for patient use and were not located in such a manner as to allow direct visualization of the patients by the nursing staff.

During an interview with the ER director at the time of discovery, she/he confirmed that none on the seven (7) ER patient rooms had an emergency call system for patient use in place. She/he had no explanation of why the rooms were not equipped with a method for patients to summon assistance if needed.

Based on review of facility policies, observation, and staff interview, it was determined that the facility failed to ensure that facility policy was followed regarding the review of heart monitor rhythm strips that were placed in patient medical records.

Findings were:

Review of facility policy, entitled Telemetry Monitors-Log for Medical/Surgical Unit, policy # 05-A-232, last revision 11/04, revealed that "Patients are monitored on the Medical/Surgical floor by the Ward Clerk with pervious training in an EKG class." The policy further required that the "Charge nurse must review all telemetry strips and initial the strip after reviewed."

During a tour with the Medical-Surgical (med-surg) manager (employee #21) of the med-surg floor on 12/07/2010 at 2:30 p.m., observations revealed that several patients were on telemetry (remote monitoring of the heart ' s rate and rhythm) monitors. Observation noted that the only person at the desk was a ward clerk, who was sitting at the far left side away from the monitors. The manager explained that the charge nurse was usually at the desk monitoring the telemetry patients, but sometimes was called away to assist other staff. He/she also explained that the ward clerk had been trained to recognize dangerous rhythms and would soon attend a class with all other ward clerks. He/she further explained that the clerk ran a rhythm strip on all telemetry patients every four (4) hours and posted them in the patient's chart for the charge nurse to review for changes/concerns.

Three (3) of three (3) patient charts reviewed revealed that the rhythm strips were in printed form and that three (3) to four (4) of the rhythm strips were on the same sheet of paper. When asked about the times on the strips, the manager explained that the times on the strips were the times selected (system memory), not necessarily the times printed. He/she had no explanation of how a person would determine if all the times selected were printed at the same time, rather than the required every four (4) hours. The posted strips lacked any indication (such as initials, analysis, or date/time) that anyone had reviewed the strips. During an interview on 12/07/2010 at 4:30 p.m. at the nurses' station, the Director of Nursing (DON-employee #20) confirmed that the facility required telemetry strips be documented and reviewed every four (4) hours, but the facility currently had no way of knowing what time the rhythm strips were actually run or if the strips had been reviewed. He/she also stated that the ward clerks had not attended the required EKG class, but would soon.

Based on review of facility policies and procedures, medical records, and staff interview, it was determined that the facility failed to ensure that the date and time of physician restraint orders was written and could confirm that the physician's evaluation of the patient was within the required twenty-four (24) hour time period for four (4) of four (4) sampled patient restraint records (#s 1, 2, 6 and 8).

Findings were:

Review of facility policy, entitled Restraints, Policy # MS 306b, revised 05/07, revealed that a physician or licensed independent practitioner must evaluate in person, and within one hour, all hospitalized patients who have been restrained. The policy further stated that the need for continued restraints would be evaluated by the physician in a "face to face" assessment at least every twenty-four (24) hours.

Four (4) of four (4) medical records of restraint patients reviewed (#s 1, 2, 6 and 8) revealed that the physician restraint orders lacked the time or date and time that the orders were signed. Therefore, the date and time that patients were seen and evaluated by the physician was unable to be confirmed to be within the required twenty-four (24) hour period.

During an interview on 12/09/2010 at 2:00 p.m. in the facility's conference room, the director of nurses (employee #20) and the director of quality and compliance (employee #2) affirmed that physicians failed to date and time their signatures on the restraint orders.