HospitalInspections.org

Based on review of 7 of 7 closed medical records of patients who received respiratory nebulizer treatments (aerosol treatments with bronchodilator medications) administered by nursing staff in a total sample of 13 (#1, #4, #5, #7-#9) and #13, review of 12 nurse personnel files maintained by the hospital, review of policy titled, "Respiratory Assessments/Treatments" (no reference number) and interviews, the hospital failed to ensure the nursing staff who provided specific respiratory therapy treatments for the 7 patients were trained by a licensed respiratory therapist and deemed qualified to provide the respiratory services and have this designated in writing.
Findings:

Review of form titled "Respiratory Care Services Progress Note" in the medical records for patients #1, #4, #5, #7-#9 and #13 revealed the nurses (RNs and LPNs) provided the prescribed nebulizer treatments for the patients after the respiratory therapist left at 4:30 PM. Further review revealed the nurses consistently failed to assess the patient prior to, or following the treatments to determine the effectiveness of the treatments. The nurses also frequently failed to document the patients' vital signs to determine response to the treatment and any negative side effects of the drugs used in the nebulizer.

Review of the personnel files for 8 staff RNs and 4 staff LPNs failed to reveal documentation that the nurses received training by a licensed respiratory therapist and were deemed qualified before providing respiratory treatments. In an interview on 12/07/2010 at 8:51 AM S10 RN staff nurse reported she had been an RN since 2008 but did not work until 8/2010. During the interview the survey team asked S10 RN if the hospital had provided training for administering respiratory treatments to patients and she responded "No".

An interview on 12/07/2010 at 1:00 PM with S12 respiratory therapist revealed he had been a respiratory therapist for 2 months and had worked for Caldwell Memorial Hospital for 3 weeks. He said he works Monday through Friday from 8:00 AM to 4:30 PM and is on call for emergencies.
Further interview with S12 revealed he had not provided respiratory training for staff since assuming his position at the hospital. S12 confirmed staff RNs and LPNs administer respiratory treatments on the night shift and weekends. S12 reported that staff should assess breath sounds on the patient prior to, and after each respiratory treatment. He further reported that after the treatment is completed the patient's vital signs should be assessed and documented in the medical record.

Review of the policy titled "Respiratory Assessments/Treatments" revealed "The respiratory therapist will conduct an initial evaluation of the patient within 48 hours admission. In the absence of the respiratory therapist, the appropriately in-serviced/trained Registered Nurse or Licensed Practical Nurse will administer the respiratory treatments. The respiratory therapist will be available for any questions/education as needed. The respiratory therapist will in-service the nursing staff on an annual basis".