HospitalInspections.org

Based on medical chart review and interviews the facility failed to ensure that reassessment of the patient's was conducted based on changes in patient's condition or response to treatment of 1 ( Patient # 8) of 8 patients reviewed.

Findings :

Review of the medical record for patient #8 revealed that she was admitted to the facility on 04/04/2013 after complaining of chest pain with pain radiating down her left arm. The medical record revealed that on 04/05/2013 the resident underwent a diagnostic cardiac catheterization. Review of the Post Invasive Flow Sheet revealed that the resident was in the recovery/holding area between 11:37 AM to 12:45 PM. The flow sheet revealed that the patient did not complain of chest pain during the post catheterization recovery period. At 14:45 PM the patient was transferred back to the nursing floor.

Review of a physician progress note written on 04/05/2013 art 5:00 PM revealed "Patient states that she has chest pain radiating to arm after cath, will order STAT EKG and troponin I Q 8 hours x 3".

Review of the physician orders written 04/05/2013 at 5:00 PM revealed "Nitro paste 1 inch Q 6 hours, Troponin I STAT and Q 8 Hours x 2".

Further review of chart shows on 04/05/2013 at 6:54 PM troponin is 0.19. 04/06/2013 at 2:57 AM troponin is 0.46, at 9:15 AM troponin 0.42 and 6:43 PM troponin 0.43. All three of these labs were called to Charge nurse on that night. Reference range troponin is normal 0.01-0.04, borderline 0.05 to 0.25mg/ml, positive over 0.25mg/ml or a serial incremental increase of more or equal to 0.1 ng/ml.

Review of the medical record revealed that the Laboratory staff had notified the patient's nurse of the Shift Charge nurse of the 2:57 AM results and that the Shift Charge Nurse acknowledged the "reportable" results back to the Laboratory staff.

Review of the medical record Troponin was .43 at 3; 00 AM had not called to the physician by the Shift Charge Nurse. When asked what was the reason for not notifying the physician, of the change in the patient's condition, the nurse stated that after a stent the troponin can be high. review of the medical record revealed that the patient did not have a stenting procedure.

Interview with physician on 06/06/2013 at 5;00 PM . When the Physician was asked if called about the high troponin levels would only say the nurses would call if the Troponin I levels were high. The physician then stated that he was not told of chest pain. Also stated that yes patient had small heart attack and he did tell patient.