HospitalInspections.org

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Based on interview and document review, the hospital failed to develop and implement an effective respiratory care program.

Failure to develop and implement an effective respiratory care program puts patients at risk for receiving inadequate respiratory care services.

Findings included:

The hospital failed to provide adequate numbers of personnel trained in the use of specialized respiratory care equipment and services.

Cross-reference: A1154

Due to the scope of the deficiencies cited under 42 CFR 482.57, the Condition of Participation for Respiratory Services was NOT MET.

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Based on interview and document review, the hospital failed to provide adequate numbers of personnel trained in the use of specialized respiratory care equipment and drawing of arterial blood gases.

Failure to provide adequately trained personnel puts patients at risk for receiving insufficient respiratory care.

Findings included:

1. The hospital policy titled "Cardiopulmonary Services Policy & Procedure Mechanical Ventilation", revised 10/17/18 showed that the hospital employed a model of care that designated respiratory therapists (RTs) to provide care for patients needing mechanical ventilation and with the set-up and maintenance of the ventilation equipment. The RT was also tasked with drawing the arterial blood gases (ABGs) to monitor the effectiveness of the ventilatory settings.

2. Review of the hospital's RT department staffing documentation showed that on 10/05/21, the Director of Cardiopulmonary and a staff RT called out for their scheduled shift and then gave their 2-week notice of resignation. On 10/07/21, the 3 RTs that were scheduled to work called out for their shift and then gave their 2-week notice of resignation or cancelled their travel contract with the hospital. As of 10/15/21, no RTs had shown up for work at the hospital, leaving the hospital without a staffed cardiopulmonary department.

3. Review of the hospital competencies for registered nurses (RNs) in the medical-surgical and pediatric departments, revised 05/21, critical care department, revised 09/21 and the emergency department, revised 07/21 showed that RNs did not have competencies to demonstrate proficiency with unit-specific mechanical ventilation equipment and drawing of ABGs (an arterial blood draw that measures the acid-base and levels of oxygen and carbon dioxide in the blood).

4. On 10/11/21 at 9:25 AM, Staff #2, the Health Educator was interviewed by Investigator #2. Staff #2 stated that nursing staff in the past had been trained on their unit-specific respiratory equipment and in the skill of doing ABG draws, but over the last few years respiratory therapy had taken the lead in the ABG draws and management of the respiratory therapy equipment. Staff #2 stated that they began training nursing staff on the duties of the respiratory therapy equipment management and cleaning as well as performing arterial blood gas punctures when the hospital recognized their cardiopulmonary department was no longer able to fill this patient need.

5. On 10/11/21 at 9:50 AM, Staff #4, a RN, was interviewed by Investigator #2. Staff #4 stated that nursing staff use to be more involved in the set-up and cleaning of unit-specific ventilation equipment as well as ABG punctures but were not trained on the current equipment. Since the cardiopulmonary department no longer had RT staff available as of 10/07/21, the RNs had begun receiving training on the duties that had been designated to RTs in the current hospital care model.

6. On 10/11/21 at 9:50 AM, Staff #5, a RN, was interviewed by Investigator #2. Staff #5 stated that RNs were no longer trained on unit-specific ventilation equipment and ABG punctures. Staff #5 confirmed that RNs were now receiving training on ventilation equipment and ABG punctures.

7. On 10/11/21 at 11:30 AM, Staff #1, Chief Nursing Officer, was interviewed by Investigator #2. Staff #1 verified that nursing staff used to receive training on the respiratory therapy equipment and in the procedure of doing ABG's. Staff #1 stated that nursing staff were being given training on the respiratory therapy equipment used on their specific patient care units and in the procedure to draw ABG's which started after the cardiopulmonary department staff resigned.

8. On 10/11/21 at 9:45 AM, Investigator #1 interviewed a charge RN (Staff #13) in the critical care unit (CCU). Staff #13 reported that it was RT's responsibility to maintain patient ventilation equipment and draw ABGs. Staff #13 also reported that the CCU RNs were expected to take over when the RTs suddenly resigned but they were not trained to provide RT care. The RNs called the anesthesiologist who set up the ventilation equipment and the hospitalists (physician providing medical care for patients admitted into the hospital) who began transferring patients to other hospitals. Staff #13 confirmed that their unit currently did not have the staff to care for respiratory patients and have therefore had to decline all respiratory patients.

9. On 10/11/21 at 10:00 AM, Investigator #1 interviewed a hospitalist (Staff #17). Staff #17 confirmed that the hospital unexpectantly lost their entire RT staff and that the hospitalists, emergency department providers, and anesthesiologists were currently filling the responsibilities that belonged to RT until the RNs could finish training and RTs could be hired. The physicians were setting up ventilation equipment, drawing ABGs, and transferring respiratory patients to hospitals that had enough staff to provide safe care.
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