HospitalInspections.org

Based on document review and staff interview it was determined the hospital failed to have a registered nurse (RN) present in the emergency room (ER) in accordance with §64-12-16.3.a; specifically, §64-12-12.9.c. which stipulates that a RN must be on duty and immediately available for bedside care of any patient when needed each shift, twenty-four (24) hours per day, seven (7) days per week. This failure has the potential to delay the deliverance of life-saving care to patients seeking emergency care.

Findings include:

1. A review of the staffing matrix for the ER revealed one (1) RN and one (1) licensed practical nurse staff the ER from 3:00 a.m. to 7:00 a.m. The RN in the ER acts as the In-House Supervisor.

2. A review of the staffing matrix of the acute care staff revealed one (1) RN, one (1) nurse aide and one (1) telemetry technician staff the acute care unit from 11:00 p.m. to 7:00 a.m.

3. In an interview with the Director of Nursing on 11/8/17 at approximately 8:26 a.m. she agreed with the above findings.

4. In an interview with the Medical Director of the ER on 11/8/17 at approximately 9:06 a.m. he stated there weren't many patients seen in the ER from 3:00 a.m. to 7:00 a.m.; however, they have the ability to pull a RN from the other unit. He further stated, "It's our back-up for the ER."

Based on document review and staff interview it was determined the facility failed to ensure a registered nurse (RN) was available to immediately triage patients seeking emergency care. Failure to have a RN available to triage has the potential to cause a delay in providing life-saving care to the patient.

Findings include:

1. A review of the master staffing matrix for the emergency room (ER) revealed one (1) RN and one (1) licensed practical nurse staff the ER from 3:00 a.m. to 7:00 a.m. with no designated triage nurse assigned during that time.

2. A review of the ER patient log from 08/01/17 to 10/31/17 revealed there were fifty-one (51) patients registered to be seen in the ER from 3:00 a.m. to 7:00 a.m.

3. In an interview with the Director of Nursing on 11/08/17 at approximately 8:26 a.m. she concurred with the above findings.

4. Review of the ER policy entitled "Triage", last revised 2/15, revealed it stated, in part: "Upon arrival to the ER, all patients will be evaluated by an RN..."

Based on observation, staff interview and document review it was determined the facility failed to ensure that all essential mechanical, electrical and patient care equipment is maintained in a safe operating condition in accordance with §485.623(b). Facility census 5.

Findings include:

1. Document review conducted on 11/07/17 between the hours of 8:00 a.m. and 12:00 p.m. revealed the facility failed to conduct smoke detector sensitivity in accordance with National Fire Protection Association (NFPA) 72.

2. A facility inspection tour conducted on 11/07/17 between the hours of 1:00 p.m. and 4:00 p.m. revealed the facility failed to maintain and test the automatic sprinkler system in accordance with NFPA 25. Communication wires were revealed on the sprinkler piping above the kitchen ceiling, above the corridor ceiling next to the acute care nurse station, above the corridor ceiling next to Physical Therapy and above the corridor ceiling next to x-ray.

3. Document review conducted on 11/07/17 between the hours of 8:00 a.m. and 12:00 p.m. revealed the facility failed to conduct testing of receptacles at patient bed locations in accordance with NFPA 99.

4. Document review conducted on 11/07/17 between the hours of 8:00 a.m. and 12:00 p.m. revealed the facility failed to conduct a three (3) year, four (4) hour generator load test in accordance with NFPA 110.

5. Document review conducted on 11/07/17 between the hours of 8:00 a.m. and 12:00 p.m. revealed the facility failed to maintain and test patient-care related equipment in accordance with NFPA 99.

6. The above findings were discussed with the Administrator and the Director of Support Services on 11/07/17 at approximately 4:00 p.m. and agreed the deficiencies needed corrected.

Based on document review and staff interview it was determined the facility failed to provide adequate nursing staff to meet the needs of the patients. This failure has the potential for insufficient care, treatment and delivery of all patients receiving care at the facility.

Findings include:

1. A review of the staffing matrix for the emergency room (ER) revealed one (1) Registered Nurse (RN) and one (1) Licensed Practical Nurse staff the ER from 3:00 a.m. to 7:00 a.m. The RN in the ER acts as the In-House Supervisor.

2. A review of the staffing matrix for the acute care staffing revealed one (1) RN, one (1) nurse aide and one (1) telemetry technician staff the acute care unit from 11:00 p.m. to 7:00 a.m.

3. In an interview with the Director of Nursing on 11/08/17 at approximately 8:26 a.m. she agreed with the above findings.

4. In an interview with the Medical Director of the ER on 11/08/17 at approximately 9:06 a.m. he stated there weren't many patients seen in the ER from 3:00 a.m. to 7:00 a.m.; however, they always have the ability to pull a RN from the other unit. He further stated, "It's our back-up for the ER."