HospitalInspections.org

Based on interview and document review it was determined that the Emergency Department (ED) did not have adequate nurse staffing on 7 of 7 days reviewed. Potentially affecting all patients entering the ED for treatment.

Findings include:

1. During an interview on 8/31/16 at 10:40 AM, the ED Manger (E#2) stated, "We have a 22% vacancy rate in the ED. The staffing pattern in place is: 7 AM = 8 nurses, 9 AM = 10 Nurses, 11 AM - 11 PM = 11 nurses, 11 PM = 9 nurses and 3 AM = 7 nurses.

2. The daily staffing sheets for 7/17/16 - 7/23/16 were reviewed on 8/31/16. The following days and times were short nurses based on manager interview (no written staffing guidelines available) :

7/17/16 - 1 nurse at 7 AM; 2 nurses at 9 AM, 11 AM and 3 PM; 3 nurses at 7 PM; 2 nurses at 11 PM, and 1 nurse at 3 AM
7/18/16 - 1 nurse at 3 PM and 7 PM
7/19/16 - 3 nurses at 7 PM and 11 PM, and 1 nurse at 3 AM
7/20/16 - 1 nurse at 9 AM; 2 nurses at 11 AM and 3 PM; 3 nurses at 7 PM and 11 PM, and 2 nurses at 3 AM
7/21/16 - 1 nurse at 9 AM, 11 AM and 3 PM; 2 nurses at 7 PM, and 1 nurse at 11 PM
7/22/16 - 1 nurse at 7 AM; 2 nurses at 9 AM; 2 nurses at 11 AM; 1 nurse at 3 PM; 2 nurses at 7 PM, and 1 nurse at 3 AM.
7/23/16 - 1 nurse at 9 AM and 11 AM; 3 nurses at 3 PM; 4 nurses at 7 PM; 3 nurses at 11 PM, and 1 nurse at 3 AM

3. During an interview on 8/31/16 at approximately 1:30 PM, the ED Manager (E#2) stated, "I know we are short staffed, but I am trying to get the nurses we need. It has been a long process. As we hire, people leave". E#2 stated this does have a direct impact on wait times because they try to keep the 4 to 1 patient to staff ratio for safety.

Based on document review and interview it was determined for 3 of 7 (Pt.s # 3, #4, and #6) Emergency Department patient records reviewed, it was determined the hospital failed to ensure patient reassessments were completed as per policy.

Findings include:

1. The Hospital policy titled, "Assessment & Reassessment of Patients (reviewed 11/14)" was reviewed on 8/31/16. The policy required, "Reassessment includes vital signs... Reassessment schedule: Every 4 hours on stable category III patients..."

2. The clinical record of Pt. #3 was reviewed on 9/1/16. Pt. #3 was a 61 year old male who presented to the emergency department (ED) on 7/20/16 at 12:32 PM with complaints of diarrhea and vomiting. Pt. #3 was a category III (stable). Pt. #3 had vital signs (blood pressure, temperature, pulse) taken at 12:52 PM and again at 8:54 PM (8 hours later).

3. The clinical record of Pt. #4 was reviewed on 9/1/16. Pt. #4 was a 50 year old female who presented to the ED on 7/20/16 at 1:06 PM with the complaint of chest pain. Pt. #4 was a category III. Pt. #4 had vital signs taken at 1:31 PM and again at 7:41 PM (6 hours later).

4. The clinical record of Pt. #6 was reviewed on 9/1/16. Pt. #6 was a 50 year old female who presented to the ED on 7/20/16 at 1:29 PM with the complaint of headache. Pt. #6 was a category III. Pt. #4 had vital signs taken at 1:43 PM and again at 9:25 PM (approximately 8 hours later).

5. During an interview on 8/31/16 at approximately 1:30 PM, the ED Manager (E#2) stated, "We don't require a reassessment of patients waiting in the waiting room, but we do have reassessment guidelines for ED patients".