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Based on interview, medical record review, and review of the facility's policy, it was determined the facility failed to ensure nursing supervision of patients was performed as per facility policy and Physician's orders as evidenced by daily vital signs not being documented at least once daily for eight (8) of ten (10) sampled patients (Patients #1, #2, #3, #4, #6, #7, #8, and #9).

The findings include:

Review of the facility's policy titled, "Vital Signs, Behavioral Health Unit," policy number BH-V-04, revised 12/02/13, revealed the Behavioral Health Unit (BHU) would monitor vital signs (temperature, pulse, respirations, and blood pressure) in order to provide safe and effective holistic care to patients. Continued review of the policy revealed vital signs would be monitored on admission, daily, whenever a nursing assessment indicated a need, or when there was a change in the patient's condition. The policy further revealed vital signs should be documented in the patient's chart, and the Attending Physician or designee should be notified of any unusual findings.

1. Review of Patient #1's medical record revealed he/she was admitted to the BHU on 05/14/14, with diagnoses which included Bipolar Disorder, Not Otherwise Specified (NOS) and Impulse Control Disorder (NOS). Vital signs were ordered by the Physician to be obtained daily; however, there was no documented evidence vital signs were obtained on 05/20/14, the day of discharge.

2. Review of Patient #2's medical record revealed he/she was admitted to the BHU on 05//28/14, with diagnoses which included Depressive Disorder NOS, Alcohol Abuse and Dependence and Borderline Personality Disorder. Vital signs were ordered by the Physician to be obtained daily; however, there was no documented evidence vital signs were obtained on 05/30/14, the day of discharge.

3. Review of Patient #3's medical record revealed he/she was admitted to the BHU on 05/19/14, with Depressive Disorder NOS and Cocaine Abuse/Dependence. Vital signs were ordered by the Physician to be obtained daily; however, there was no documented evidence vital signs were obtained on 05/20/14 or 05/21/14, the day of discharge.

4. Review of Patient #4's medical record revealed he/she was admitted to the BHU on 05/18/14, with a diagnosis of Paranoid Schizophrenia. Vital signs were ordered by the Physician to be obtained daily; however, there was no documented evidence vital signs were obtained on 05/19/14, 05/20/14 or 05/21/14.

5. Review of Patient #6's medical record revealed he/she was admitted to the BHU on 05/18/14, with diagnoses including Paranoid Schizophrenia and Depression NOS. Vital signs were ordered by the Physician to be obtained daily; however, there was no documented evidence vital signs were obtained on 05/21/14, the day of discharge.

6. Review of Patient #7's medical record revealed he/she was admitted to the BHU on 05/14/14, with a diagnosis of Psychotic Disorder NOS. Vital signs were ordered by the Physician to be obtained daily; however, there was no documented evidence vital signs were obtained on 05/16/14 or 05/17/14.

7. Review of Patient #8's medical record revealed he/she was admitted to the BHU on 02/04/14 for Medication Noncompliance. Vital signs were ordered by the Physician to be obtained daily; however, there was no documented evidence vital signs were obtained on 02/07/14 or 02/18/14.

8. Review of Patient #9's medical record revealed he/she was admitted to the BHU on 04/13/14, with diagnoses including Bipolar Disorder NOS, Suicidal Ideations, and Cocaine Abuse. Vital signs were ordered by the Physician to be obtained daily; however, there was no documented evidence vital signs were obtained on 04/14/14 or 04/15/14.

Interview with Registered Nurse (RN) #1 on 05/31/14 at 1:10 PM, revealed every patient should have vital signs taken at least daily on the BHU. RN #1 revealed she recorded the vital signs on her "personal sheet", and it was possible that vital signs would be obtained and not documented in the medical record. She stated however, the correct procedure would be to document the vital signs in the patient's medical record.

Interview with the BHU Nurse Manager on 06/02/14 at 2:30 PM, revealed she believed vital signs were being obtained every morning as a routine process of the nursing assessment. She stated vital signs should be taken at least daily for use as a comparison or to gauge the patient's reaction to medications. The BHU Nurse Manager revealed all the patients with missing vital signs should have had them taken as per facility policy. She indicated if the vital signs were obtained the results should have been documented in the patients' medical records.