HospitalInspections.org

Based on a review of facility documents and staff interviews (EMP), it was determined that LECOM Health Millcreek Community Hospital failed to ensure that patient care assignments were commensurate with the qualifications of each nursing member, the identified needs of the patient, and the prescribed medical regimen.

Findings include:

Review, at 6:21 PM on January 31, 2017, of LECOM Health Millcreek Community Hospital, Scope of Services, Department of Nursing, revised October 2016, revealed, "... The Team shall consist of registered nurses, licensed practical nurses and nurse aides. ... Roles of Personnel:Role of the RN:1. Assumes responsibility and accountability for all patients in Team assignment as well as providing direct care to some patients which includes teaching, physical and psychological comfort to patient and family. 2. Assesses each patient and identifies and prioritizes patient needs. ... H. Intensive/Cardiac/Surgical Care Unit: ... The above disciplines are concentrated in one critical care area. Six (6) bed capacity providing critical care needs to patient population served ... In addition to the primary RN, additional staffing is accomplished by RN's and usage of special trained LPN's and Nurses Aides ... ."

Review, at approximately 6:40 PM on January 31, 2017, of Nursing Policy S-24, Staffing Guidelines, effective June 30, 2016, revealed, "... Policy: Staffing guidelines are based on a combination of census and individual patient needs. There is to be at least one registered professional nurse of each tour of duty for each 24 hour unit. There shall be at least one registered nurse to supervise, direct and provide care. There shall be additional nursing staff (additional RN's, LPN's and NA's) as deemed necessary based on staffing guidelines for the present census and acuity Guidelines: 1. The nursing supervisor/unit leaders will monitor census throughout the shift. They will document the census on the staffing sheet by 5:00 a.m. for 1st shift, 1:00 p.m. for 2nd shift and 9:00 p.m. for 3rd shift. 2. The nursing supervisor/unit leaders will assess patient needs throughout the shift to determine the need for additional staff. 3. Patient assignments are to be made by the RN Charge Nurse taking into consideration the following: Patient needs Complexity of patients. Any special needs of patients. Competence of nursing personnel. Qualifications of nursing personnel. Education of nursing personnel. Experience of nursing personnel ... 5. The nursing supervisor/unit leaders will document the census on the staffing sheet ... ."

1. Review of Millcreek Hospital Intensive Care Unit schedules from December 26, 2017 through January 31, 2017, revealed that the schedules indicating who worked on the Unit, but did not indicate which staff member was assigned to each patient.

2. On January 31, 2017, at approximately 11:23 AM daily staffing sheets were requested. EMP8 stated that there are no staffing sheets for the ICU [Intensive Care Unit] patient. EMP8 further indicated, "We get report and pick our patients, then we just tell the Charge Nurse who has which patient for the day/evening."

3. Interview with EMP5 on February 1, 2017, at approximately 11:30 AM, confirmed that there were no assignment sheets indicating which staff was assigned to each ICU patient.