HospitalInspections.org

1. Based on review of medical records, policy and procedure, and staff interview, the facility failed to ensure that a registered nurse evaluate and document the review of EKG strips for patients on continuous cardiac monitoring. The facility also failed to ensure that a registered nurse evaluate and document the review of EKG out of parameter alarms for patients on continuous cardiac monitoring and notify the physician when appropriate.

The findings include the following:

a. Review of medical records on 9/10/13 at the facility nurse's station revealed that patients receiving continuous cardiac monitoring did not have consistent documentation that a registered nurse reviewed the patient's rhythm strip. Also the patients receiving continuous cardiac monitoring did not have consistent documentation that a registered nurse reviewed the patient's rhythm strip when out of parameter alarms occurred.

The following was noted:

(P1) admitted 9/6/13 with a physician order for telemetry monitoring revealed no EKG strips on the patient chart for 9/7, 9/8, 9/9, and 9/10/13

(P2) admitted 9/6/13 with a physician order for telemetry monitoring revealed no EKG strips on the patient chart 9/8, 9/9, and 9/10/13

Review of EKG Alarm Table for (P2) from 09/09/13 at 10:14PM to 09/10/13 at 11:46AM revealed 40 out of parameter alarms. 28 of those out of parameter alarms were listed as HIGH priority. The HIGH priority alarms were Tachycardia & Bradycardia. Medium priority alarms were Trigeminy and Ventricular Tachycardia. There was no documentation that EKG strips were reviewed and no documentation found that the out of parameters alarms were addressed. No documentation found that the physician was notified.

b.Procedure under nursing service. Telemetry Monitoring stated procedures to continuously record patient ' s heart pattern. Collect strips and recall every p.m. 0700, 1500, & 2300 if applicable for all times listed.

c. Staff interview with (S1) on 9/10/13 at 12:30pm in the facility's nurse ' s station confirmed that (P1) and (P2) did not have EKG strips printed for the above missing dates. (S1) stated that it was the Respiratory Therapist on the evening shift ' s responsibility to print the EKG strip and place in the patient's chart.

Staff interview with (S2) on 9/10/13 at 12:45 in the facility's nurses' station confirmed that (P1) and (P2) did not have EKG strips placed in the chart for the above dates. (S2) stated that the charge RN was responsible for the EKG review. (S2) stated that the EKG strips should be reviewed every 4 hours. (S2) could not produce a policy that directed the nursing staff on frequency of documentation of EKG review or steps to take for EKG changes. (S2) could not produce documentation that the RN was notified of out of parameter alarms and or documentation that the RN addressed the out of parameter alarms.

1. Based on observation, review of medical records, policy and procedure,employee files, and staff interview, the facility failed to assign a competent staff member to monitor the patients on continuous cardiac monitoring. The facility failed to have policy and procedures in place to direct the nursing staff on the care of the patient on continuous cardiac monitoring.

The findings include the following:

a. Based on observation on 9/10/13 at 12:00pm in the nurses' station revealed the telemetry monitoring station was being monitored by the unit clerk (S3). The unit clerk was observed multiple times leaving the telemetry monitor station area to perform other assigned duties.

b. Review of medical records on 9/10/13 at the facility nurse ' s station revealed that patients receiving continuous cardiac monitoring did not have consistent documentation that a registered nurse reviewed the patient's rhythm strip when out of parameter alarms occurred and no documentation was found that the RN was notified of out of parameter alarms

The following was noted:

Review of EKG Alarm Table for (P2) from 09/09/13 at 10:14PM to 09/10/13 at 11:46AM revealed 40 out of parameter alarms. 28 of those out of parameter alarms were listed as HIGH priority. The HIGH priority alarms were Tachycardia & Bradycardia. Medium priority alarms were Trigeminy and Ventricular Tachycardia. There was no documentation that EKG strips were reviewed and no documentation found that the out of parameters alarms were addressed. No documentation found that the physician was notified.

c. Review of policy and procedures manuel on 09/10/13 titled Telemetry Monitoring stated procedures to continuously record patient's heart pattern for 24 hour periods. Collect strips and recall every p.m. 0700, 1500, 2300 if applicable for all times listed. There was no policy found that directed the nursing staff on the care of the patient on continuous cardiac monitoring.

d. Review of employee files on 9/10/13 for (S9) supervising RN revealed that she had no EKG competency evaluation on file.

e. Staff interview with the unit clerk (S3) on 9/10/13 at 12:10pm revealed she was not able to articulate basic understanding of heart rates. When asked what was a normal heart rate (S3) stated 100 to 120. When asked what was too low of a heart rate (S3) stated below 40. When asked when she would alert the RN of out of parameter heart rates (S3) stated a heart rate over 120 and below 40.

Staff interview with (S2) on 9/10/13 at 2:45 in the facility's conference room confirmed that (S9) did not have competency training for EKG interpretation in her employee file. (S2) stated that there has not been any EKG training classes held after (S9)'s hire date. (S9) has held her position for several months.