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Based on clinical record review and interviews, it was determined the Facility failed to ensure a Registered Nurse supervised, evaluated and followed Physician's Orders for two (#6 and #8) of six (#1, #2, #6, #8, #11 and #13) Patients in that ordered baths were not given; three (#1, #10 and #11) of fifteen (#1-15) Patients did not have vital signs obtained as ordered; one (#11) of two (#1 and #11) Patients with orders to record diaper weights did not have diaper weights recorded; and neurological scores were not recorded for one (#10) of one Patient as ordered by the Physician. Failure to give baths as ordered, obtain vital signs, record diaper weights, and record neurological scores did not give the Physicians the necessary information needed to make decisions regarding patient care and treatment. The failed process affected Patients #1, #2, #6, #8, #11 and #13. Findings follow:

A. Review of the clinical record for Patient #6 revealed Physician's Orders dated and timed 01/14/17 at 1159 to bathe Patient after two consecutive temperatures of 98 degrees or above. Review of the clinical record revealed no documentation a bath was given. During an interview with the Labor and Delivery Manager at 1114 on 05/11/17 she verified the above.

B. Review of the clinical record for Patient #8 revealed Physician's Orders dated and timed 05/08/17 at 0818 to bathe Patient after two consecutive temperatures of 98 degrees or above. Review of the clinical record revealed no documentation a bath was given. During an interview with the Labor and Delivery Manager at 1456 on 05/10/17 she verified the above findings.

C. Review of the clinical record for Patient #1 revealed Physician's Orders dated and timed 01/14/17 at 2201 for vital signs to be checked every 15 minutes for four times, every thirty minutes for two times and then every one hour. Review of the clinical record revealed no documentation the vital signs were checked every hour on 01/15/17 through discharge on 01/21/17. In addition blood pressure readings were not checked at every set of vital signs to ensure a complete set of vital signs were obtained on the above days. During an interview with the Assistant Director of Women's Services at 1337 on 05/10/17 she verified the above findings.

D. Review of the clinical record of Patient #11 revealed Physician's Orders dated and timed 05/06/17 at 1107 to record every diaper weight. Review of the clinical record from 05/05/16 at 1631 to 05/10/17 at 0700 revealed no recordings of diaper weights. During an interview with Registered Nurse (RN) #1 at 1514 on 05/10/17 she verified the above findings. Review of the clinical record for Patient #11 revealed Physician's Orders dated and timed 05/06/17 at 1107 for vital signs to be checked every thirty minutes for two times and then every one hour thereafter. Review of the clinical record revealed no documentation the vital signs were obtained from 1107 til 1330 on 05/06/17, and no documentation vital signs were obtained every one hour as ordered from 1330 on 05/06/17 through 05/11/17 at 0700. During an interview with the Director of Accreditation at 1011 on 05/11/17 she verified the above findings.

E. Review of the clinical record of Patient #10 revealed Physician's Orders dated and timed 01/06/17 at 1156 for vital signs to be checked every one hour until specified. The next Physician Order dated and timed 01/07/17 at 0434 revealed vital signs were to be checked every four hours for twelve hours, then every 8 hours thereafter. Review of the clinical record revealed no documentation the vital signs were checked every one hour, every four hours and then every eight hours respectively. During an interview with the Labor and Delivery Manager at 0926 on 05/12/17 she verified the above findings. Review of the clinical record of Patient #10 revealed Physician's Orders dated 01/06/17 at 1314 for neurological assessments to be performed every 15 minutes for four times, then every 30 minutes during the epidural infusion from 1320 on 01/06/17 til 0600 on 01/07/17. Review of the clinical record revealed no documentation the neurological assessments were performed as ordered. During an interview with the Labor and Delivery Manager at 0930 on 05/12/17 she verified the above findings.