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Based on observation, interview, and policy review, the provider failed to ensure the registered nurse (RN) M conducted patient monitoring in accordance with acceptable standards of practice for one of one sampled patient (42) who received conscious intravenous (IV) sedation. Findings include:

1. Observation on 10/31/13 of patient 42's colonoscopy procedure with biopsies revealed:
*At 12:20 p.m. RN M ambulated the patient to procedure room A, applied oxygen by nasal canula, and applied monitoring devices for the patient's blood pressure, electrocardiogram (ECG), pulse, and oxygen saturation.
*At 12:42 p.m. RN M administered the patient Demerol and Versed to provide IV conscious sedation during the procedure.
*At 12:50 p.m. the patient was fidgety and removed the pulse oximetry.
RN M was at the foot of the stretcher assisting the physician obtain specimens by controlling the biopsy forceps. The surgical technologist stood next to the physician and advanced or retracted the scope as the physician directed.
*At 1:03 p.m. the pulse oximetry remained off the patient's finger, and RN M was at the foot of the stretcher operating the biopsy forcep for the physician.
*At 1:05 p.m. RN M noticed the pulse oximetry was off the patient's finger and replaced it.
*At 1:07 p.m. RN M was at the foot of the patient's stretcher. She assisted the physician with the biopsy forcep and placed the specimen into a specimen cup.
*At 1:09 p.m. the patient removed the pulse oximetry. RN M and the physician noted the patient had removed the pulse oximetry. RN M was assisting with obtaining biopsy specimens, the surgical technician was holding the scope in place, and the physician was directing RN M when to open and close the biopsy forcep. There was no other staff in the room to reapply the patient's pulse oximetry. The nurse called up from the foot of the stretcher and asked the patient how she was doing. The patient was fidgety and no verbal response was heard by the surveyor.
*At 1:18 p.m. RN M reapplied the patient's pulse oximetry.
*At 1:20 p.m. RN M removed the pulse oximetry from the patient's finger and disinfected it with a CaviWipe.

Review of patient 42's progress note dated 10/31/13 documenting her conscious sedation monitoring revealed:
*There was no pulse oximetry reading for her oxygen saturation at 12:55 p.m., 1:00 p.m., 1:10 p.m. 1:15 p.m., and 1:20 p.m.
*At 1:14 p.m. the nurse documented the patient responded to verbal stimuli. There were no additional documentation of verbal commands documented by RN M during the patient's procedure.

Interview on 10/31/13 in the afternoon with the director of surgical services revealed:
*RN M's main responsibility should have been monitoring the patient's conscious sedation status.
*RN M was allowed to assist with interruptible tasks of short duration. RN M should have requested additional staff to assist with specimen collection to ensure she was able to continually monitor the patient's condition.

Review of the provider's August 2013 Moderate/Conscious Sedation, Monitoring/Disposition of Patient Receiving policy revealed:
*"The nurse's primary responsibility will be to monitor the patient but may also assist with interruptible ancillary tasks of short duration provided that the patient's condition is stable and adequate monitoring is maintained."
*Each patient should have been monitored and care documented on the flowchart/sheet as follows:
-"Vital signs, blood pressure, pulse every 5-15 minutes continual and oxygen saturation by use of oximeter."
-"Level of consciousness every 15 minutes including response to verbal commands."
*The purpose was "To provide safe, effective administration and care of adult (for the purpose of this policy, age 14 and over) patients receiving moderate/conscious sedation. This policy does not apply to monitored anesthesia care administered by anesthesia personnel or in emergency situations."
*"Moderate sedation/analgesia "conscious sedation": A drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patient airway, and spontaneous ventilation is adequate. Cardiovascular functions is usually maintained."

Review of the Association of periOperative Registered Nurses, Perioperative Standards and Recommended Practices, 2012 Edition, Denver, CO, revealed:
*Page 412, Recommendation IV stated:
-"The perioperative registered nurse monitoring the patient receiving moderate sedation/analgesia should have no other responsibilities that would require leaving the patient unattended or would compromise continuous monitoring during the procedure.
-Continuous monitoring of the patient's physiological and psychological status by the perioperative registered nurse leads to early detection of potential complications.
-A designated perioperative registered nurse should continually monitor the patient during administration of moderate sedation/analgesia."
*Page 414, Recommendation VI stated:
-"The perioperative registered nurse should continuously monitor the patient throughout the procedure.
-Continuous monitoring throughout the procedure enables the perioperative registered nurse to use clinical data to implement or modify the plan of care.
-The perioperative registered nurse, at a minimum, should continuously monitor the patient's heart rate and function via electrocardiogram (ECG); oxygenation using pulse oximetry, respiratory rate and adequacy of ventilation; blood pressure; level of consciousness (LOC); comfort level; and skin condition at regular intervals."