HospitalInspections.org

Based on review of records and interview the facility failed to enforce policies and procedures to ensure that 1 out of 9 emergency room nurses reviewed was current in basic life support (BLS) certification as required per facility policy to be employed as a registered nurse in the emergency department. This deficient practice had the likelihood to cause improper or unqualified care to patients presenting to the Emergency Department.

Findings include:

A review of the facility job descriptions for a registered nurse for the emergency department states in part,
" Required Licenses/Certifications:
Current RN Texas Licensure or compact state
BLS (basic life support)
ACLS (advanced cardiac life support) PALS (pediatric advanced life support) within 12 months of hire
TNCC (trauma nursing core course) within 18 months of hire"

A review of Staff #9's employee file revealed an expired basic life support (BLS) certification that expired as of 5/2022.

A review of the nursing schedule for the emergency room for the month of October 2022 showed staff #9 worked approximately 13 out of 31 days with an expired basic life support certification.

In an interview on 11/15/2022 at 4:00 pm with Staff #25 who is the Director of Clinical Quality and Staff #2 who is the Chief Nursing Officer the surveyor was notified that Staff #9 was suspended on 11/15/2022 for not having the required basic life support certification."

Based on review of records and interviews the facility failed to perform an appropriate medical screening examination in the emergency department (ED) to determine if the patient was stable or had an emergency medical condition in 2 out of 6 charts reviewed for medical screening exam (MSE).

Review of patient #17's chart revealed he was triaged on 9/25/2022 at 12:23 pm for level 3 on the emergency severity index (ESI) for abdominal pain. There were no additional vital signs or documentation until 09/25/2022 at 5:10 pm where it was noted the patient had left without treatment (LWOT). There was no physician documentation of a MSE located in the chart.

Review of patient #19's chart revealed he was triaged on 09/26/2022 at 2:41 pm for level 3 on the emergency severity index (ESI) for headache and vomiting. There were no additional vital signs or documentation until 09/26/2022 at 9:30 pm which showed the patient eloped. There was no physician documentation of a MSE located in the chart.

An interview was conducted on 11/15/2022 at 3:35 pm with Staff #1 who is the Emergency Room Director. The surveyor asked Staff #1 if he could explain how triage was performed and why there would be no repeat vital signs or reassessment on patients that had been in the waiting room for an extended period. Staff #1 stated, "It has been difficult with staffing and getting experienced providers to always be in triage. We try to place a more experienced nurse in triage if possible."

An interview was conducted on 11/15/2022 at 5:00 pm with Staff #24 who is the CEO and Staff #25 who is the Director of Quality Improvement. The surveyor informed the staff of the findings and asked for an explanation as to why there would be no medical screening performed. Staff #24 stated, "Staffing has been an issue since covid slowed down we don't have the same level of resources available, but the volume has increased along with the wait times."