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SAINT ANTHONY MEDICAL CENTER
RN SUPERVISION OF NURSING CARE
Tag No.: A0395
Based on document review and interview, it was determined that for 3 of 5 (Pt. #1, Pt. #2 and Pt. 6) Emergency Department (ED) patients reviewed for extended waiting room times, the Hospital failed to ensure patients were monitored every 2 hours, as per policy.
Findings included:
1. The Hospital's policy titled, "Triage and Admission to the Emergency Department (9/4/2020)" was reviewed on 12/21/2020 and required, "Patients in the waiting room will be reassessed as condition warrants or a minimum of at least once every 120 minutes. Reassessments will be documented on the patient's medical record."
2. The clinical record of Pt. #1 was reviewed on 12/21/2020. Pt. #1 presented to the ED on 11/9/2020 at 10:44 AM with complaints of shortness of breath. Per the ED notes, Pt. #1 completed triage on 11/9/2020 at 11:40 AM and was placed in the waiting room, until a bed became available in the ED. After being triaged, while in the waiting room, Pt. #1 had vital signs (blood pressure, temperature, pulse and respirations) performed at 1:25 PM and 2:19 PM, no other vital signs were documented. Pt. #1 left AMA (against medical advice) at 7:25 PM (5 hours).
3. The clinical record of Pt. #2 was reviewed on 12/21/2020. Pt. #2 presented to the ED on 10/8/2020 at 1:39 PM with complaints of fever and back pain. Per the ED notes, Pt. #2 completed triage on 10/8/2020 at 2:27 PM and was placed in the waiting room. The clinical record lacked vital signs after the original, performed during triage at 2:27 PM. Pt. #2 left AMA on 10/8/2020 at 8:15 PM (6 hours).
4. The clinical record of Pt. #6 was reviewed on 12/22/2020. Pt. #6 presented to the ED on 11/9/2020 at 9:51 AM with complaints of throwing up blood. Per the ED notes, Pt. #6 completed triage on 11/9/2020 at 10:05 AM and was placed in the waiting room. Pt. #6 had vital signs performed at 12:00 PM and 1:35 PM, no other vital signs were documented. Pt. #6 left AMA at 6:20 PM (5 hours).
5. The Triage Nurse (E#6) on duty was interviewed on 12/22/2020 at 10:15 AM. E#6 stated that patients are triaged based on their chief complaint as they arrive. E#6 stated, "Depending on our patient census, a patient may be required to remain in the waiting room until a bed opens up in the department. They could be there for several hours." E#6 stated that if a patient is in the waiting room, they need to be checked on at least every 2 hours or more often if needed.