HospitalInspections.org

Based on record review, review of the facility's Policy and Procedures, and staff interviews, the facility failed for 1 of 10 patients (Patient #1) to have the registered nurse(s) evaluate the care provided and to implement appropriate nursing measures to provide cardiac telemetry monitoring.

Findings:

During an interview on 5/10/2017 at 1:24 PM with the Director of Nursing Administration, Staff A, he stated, "when there is an order for cardiac telemetry, strips are run every 4 hours and these strips are placed in the patient's medical record, and reviewed by the physician. There are not any monitoring strips in Patient #1's medical record."
Continued interview regarding any training/in servicing of staff regarding telemetry monitoring to ensure that staff would place documentation in the patient's record, and report changes in patient's rhythm to the nurse, had not been done. Also audits to ensure that the facility was in compliance had not been done according to Staff A.

Medical record review on 5/10/2017 at 12:40 PM revealed that the physician ordered on 3/19/2017 at 6:25 AM, for Patient #1 to have Cardiac Telemetry Monitoring. The process is for the staff to place the telemetry monitor on the patient and strips are run every 4 hours and placed on the chart. Medical record review did not reveal any telemetry strips for Patient #1.

Review of the facility's Policy and procedures titled "Telemetry Monitoring" revealed the following::
Scope: Departments providing telemetry monitoring for inpatient and observation status patients.
Policy: Continuous cardiac monitoring is available 24 hours a day, 7 days a week, based on the physician order for cardiac monitoring in accordance with the guidelines described in this policy.
Monitor Technicians (MT) will be responsible for continuous monitoring and communicating changes in patient's rhythm to the nurse.
Monitor Technician Responsibilities. The Monitor Technician will print the electronic worksheet at the beginning of each shift and utilize the worksheet throughout their shift to track patients and pertinent information.
Cardiac rhythms are printed and documented on admission and at 4 hour intervals, for any rhythm and/or rate changes, and as requested by the nurse for changes in patient condition. Suggested times are 0700, 1100, 1500, 1900, 2300 and 0300.