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Based on medical record review and staff interview it was determined the facility failed to ensure a registered nurse supervised and evaluated the nursing care related to intake assessment and interventions for one (#3) of ten patients sampled.

Findings include:

Patient #3 was admitted to the facility on 1/31/2015 with a diagnosis of acute lower back pain. The physician admitted the patient for pain management.

Nursing assessment upon admission revealed the patient was alert and oriented to person, place and time. Nursing assessed the patient every shift with no change noted until 2/7/2015 at 7:00 a.m. Nursing noted the patient had a change in mental status.

Review of the patient's intake revealed the patient refused dinner on 2/6/2015 at 6:00 p.m. and had zero intake. The patient had 50 ml (milliliters) of fluid on 2/7/2015 at 3:00 a.m. Nursing noted the patient refused all meals on 2/7/2015 and had zero fluid intake.

Review of documentation revealed on 2/8/2015 the patient refused all three meals and had 0 fluid intake. Physician progress note, dated 2/8/2015, diagnosed acute kidney injury likely pre-renal due to dehydration. Testing revealed the patient was also positive for a urinary tract infection.

An interview with the Nurse Manager of 4 South was conducted on 3/24/2015 at 3:45 p.m. She reviewed the patient's record and confirmed the findings.

Based on personnel file review, policy review and staff interview it was determined the facility failed to ensure adequate evaluation of clinical activities of non-employee nursing personnel for two (A, B) of six personnel files reviewed.

Findings include:

Review of two contracted employee personnel files revealed the following:
Contract Registered Nurse #A first assignment dated on 4/9/2013. Review of the personnel file revealed no evidence a performance evaluation was completed by the facility since the RN's (Registered Nurse) initial assignment to the facility on 4/9/2013.

Contract Registered Nurse #B first assignment date was on 2/10/2010. Review of the personnel file revealed no evidence a performance evaluation of the nurse was completed by the facility since the RN's initial assignment to the facility on 2/10/2010.

Review of the facility policy "Utilization of Supplemental Staff, Agency, Contract Staff" policy #2-2-016 stated on page 2, (6) Performance Evaluation of Agency/Traveler/Flex and Mobile Float Pool staff: (a) The Hospital will participate in the evaluation mechanism identified by the contracting agency. Evaluations will be performed by the Director/Manager or designee. Agency staff will be evaluated the first shift worked utilizing institutional evaluation sheets and minimally annual thereafter.

An interview with the Manager for Central Staffing and Patient Placement on 3/24/2015 at approximately 4:15 p.m. confirmed the above findings.