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Based on record reviews and interview, the hospital failed to ensure Patient Observation Sheets were complete as evidenced by having missed entries of patient rounding and late patient rounding entries for 2 (#4, #5) of the 5 (#1-#5) Patient Observation Sheets reviewed.
Findings:

Review of policy and procedure titled " Levels of Observation" effective 9/1/2011 and most recently approved on 1/24/2023 revealed, in part, Electronically Enhanced Observation: When staff member makes contact with the patient, either for an observation (such as with Close Observation) or to establish a snapshot for documenting contact (for example, both Line of Sight and 1:1 Observation require continuous observation but documentation occurs every fifteen minutes), the employee must approach the patient in a close proximity to allow the employee's tablet to link with the patient's Beacon. The close proximity required ensures that the patient is closely observed and for a length of time to confirm signs of life.

Review of Patient #4's Patient Observation Sheets dated 02/10/2023 to 02/21/2023 revealed the following missed or late patient rounding entries: 02/10/2023 at 10:15 p.m.; 02/11/2023 at 7:15 p.m.; 02/12/2023 at 3:00 a.m.; 02/13/2023 at 12:00 a.m., 12:30 a.m., 12:45 a.m., 1:00 a.m., 1:15 a.m., 1:45 a.m., 2:00 a.m., 2:15 a.m., 10:00 a.m., and 5:00 p.m.; 02/14/2023 at 12:30 p.m.; 02/17/2023 at 5:15 a.m.; 02/18/2023 at 5:00 a.m., 9:30 a.m., 7:00 p.m.; 02/19/2023 5:00 p.m. and 5:15 p.m.; 02/20/2023 11:30 a.m.; 02/21/2023 at 12:30 a.m.

In an interview on 06/27/2023 at 11:15 a.m., S2ADON verified that the incomplete areas on Patient #4's Patient Observation Sheets from 02/10/2023 to 02/21/2023 were either late patient rounding entries or missed patient rounds.

Review of Patient #5's Patient Observation Sheets dated 02/08/2023 to 02/15/2023 revealed the following missed or late patient rounding entries: 02/08/2023 at 9:30 a.m., 10:00 a.m., and 6:15 p.m.; 02/09/2023 at 9:30 a.m.; 02/10/2023 at 2:00 a.m.; 02/11/2023 at 8:45 p.m. and 9:45 p.m.; 02/12/2023 at 3:00 a.m. and 6:15 p.m.; 02/13/2023 12:00 a.m., 12:30 a.m., 12:45 a.m., 1:00 a.m., 1:15 a.m., 1:45 a.m., 2:00 a.m., 2:15 a.m., 10:00 a.m., and 5:00 p.m.; 02/15/2023 at 12:30.

In an interview on 06/27/2023 at 11:15 a.m., S2ADON verified that the incomplete areas Patient #5's Patient Observation Sheets from 02/08/2023 to 02/15/2023 were either late patient rounding entries or missed patient rounds.

Based on record reviews and interview, the registered nurse failed to supervise and evaluate the nursing care of each patient. This deficient practice was evidenced by:
1. Failure of the nursing staff to obtain laboratory blood testing as ordered by the physician for 1 (#5) of 5 (#1-#5) patients sampled; and,
2. Failure of the nursing staff to comply with state regulations for required reporting of infectious diseases. This deficient practice is evidenced by failure to report a positive titer for syphilis in 1 (#4) of 1 (#4) record reviewed.
Findings:

1. Failure of the nursing staff to obtain laboratory blood testing as ordered by the physician for 1 (#5) of 5 (#1-#5) patients sampled; and,

Review of the policy and procedure titled "Laboratory Services" effective 09/01/2011 and most recently approved on 01/24/2023 revealed, in part, 4. The healthcare professional obtaining the specimen: a. reviews the laboratory requisition against the prescriber's order d. collects the specimen. 5. after the specimen is obtained a nurse documents in the Progress Notes section of the Medical Record: f. if the specimen was not obtained, the reason (e.g. "Patient refused to allow blood to be drawn," etc.). NOTE: If the specimen was not obtained, the nurse will notify the prescriber and document the notification and any orders received.

Review of Patient #5's Medical Record revealed a physician's order on 02/09/2023 at 8:00 a.m. for laboratory blood tests. Further review revealed there was no evidence that the laboratory blood tests were performed or documentation of physician notification regarding the reason for the specimen not being collected.

In an interview on 06/27/2023 at 11:13 a.m., S2ADON verified laboratory blood tests were not obtained by nursing staff and there was no evidence that the physician was notified.

2. Failure of the nursing staff to comply with state regulations for required reporting of infectious diseases. This deficient practice is evidenced by failure to report a positive titer for syphilis in 1 (#4) of 1 (#4) record reviewed.
According to LAC 51:II.105: The following diseases/conditions are hereby declared reportable with reporting requirements, "Class B Diseases/Conditions- Reporting Required within 1 Business Day Disease of public health concern needing timely response due to potential of epidemic spread- Report by end of the next business day after the existence of a case, a suspected case, or a positive laboratory result is known .....Syphilis."

Review of Patient #4's Medical Record revealed a positive RPR with no evidence that mandatory reporting was completed as per state regulations.

In an interview on 06/27/2023 at 1:10 p.m., S1ADM verified the positive laboratory value was not reported as required by state regulation. S1ADM verified the hospital did not have a process for reporting the infections as required by state regulations.

Based on record reviews and interview, the hospital failed to ensure nursing staff administered drugs or biologicals as ordered by the physician and according to accepted standards of practice. This deficiency is evidenced by nursing staff not administering medication according to the physician's order in 1 (#4) of 5 (#1-#5) patients sampled.
Findings:

Review of Patient #4's medical record revealed a physician's order on 02/16/2023 at 7:43 p.m. for Penicillin G 2400000 units/4 ml IM for positive RPR. Review of the medication administration record revealed on 02/16/2023 at 8:00 a.m. "med to come from pharmacy". Further review revealed there was no evidence that the nursing staff notified the physician of the reason the medication was not administered.

In an interview on 06/27/2023 at 11:05 a.m., S2ADON verified the physician's order for Penicillin G 2400000units/ 4ml IM for a positive RPR. S2ADON verified there was no documentation that the medication was not administered or notification to the physician regarding the reason for the medication not being administered.

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Based on record review and interview, the hospital failed to provide adequate numbers of nurses and mental health technicians to provide the nursing care necessary under each patient's active treatment plan for 5 (05/13/2023, 06/14/2023, 06/19/2023, 06/20/2023, 06/21/2023) of the 11 (02/08/2023, 02/09/2023, 02/10/2023, 02/11/2023, 02/12/2023, 04/14/2023, 05/13/2023, 06/19/203, 06/20/2023, 06/21/2023) days of nursing staffing scheduled sheets reviewed.
Findings:

Review of the policy and procedure titled, "Nursing Service" effective 9/1/2011 and most recently approved 01/24/2023 revealed, in part, all nursing staff members are supervised by a qualified registered nurse. Inpatient units are assigned at least one RN to each unit, 24 hours a day, and 7 days a week, to supervise and/or furnish care and to be readily available to the patient as needed. Nursing Services is integrated into the hospital-wide QAPI program. Numbers and types of nursing staff provided will be based on the needs of the patients, the qualifications and training of the nursing staff members, and the acuity of the department or unit. In patient Units: Although a minimum core staffing matrix is provided, the number and types of nursing staff members assigned to an inpatient unit will be acuity-based to determine by collaboration between the Charge Nurse and nursing leadership on duty and/or on call. The RN develops a written assignment at the start of each shift. The assignment may be updated throughout the shift, as needed. The RN assigns patient care to nursing staff members based on the individualized needs of the patient. Procedure: When the patient census is 6 or higher one of the staff members will likely be a second nurse. The specific types of staff members assigned will be dependent upon the patient needs, the skills of the employees, and the scope of practice required to render appropriate services. Special levels of observation, initiation of S/R, the level of assistance needed for ADLs and/or student nurses and employees currently listed as orienting are not represented ambulation, heightened physiological or this matrix and, if present, will be in addition to the core staffing matrix provided. A RN is required to be readily available to the patients on an inpatient unit at all times. In the event that an RN is required to leave the unit, another RN will replace the assigned RN on the unit for the duration of the absence. Throughout the assigned shift, it is the responsibility of the RN to supervise all care provided by nursing staff not licensed as RNs and ensure that a therapeutic milieu is maintained. Comply with prudent nursing practice, immediately notify their direct superiors of alleged, suspected, or witnessed abuse and/or neglect and act in good faith for the good of the patient.
Census Number of Staff
29-36 8
22-28 7
21 6
15-21 5
8-14 4
6-7 3
0-5 2

Review of 5 (04/14/2023, 05/13/2023, 06/19/2023, 06/20/2023, 06/21/2023) of the 11 (02/08/2023, 02/09/2023, 02/10/2023, 02/11/2023, 02/12/2023, 04/14/2023, 05/13/2023, 06/14//2023, 06/19/203, 06/20/2023, 06/21/2023) days of Nursing Daily Assignment sheets revealed the following:

On 04/14/2023 day shift, a beginning of shift census of 24 patients. Further review revealed a total of 5 staff assigned to the unit. Review of the matrix revealed for 24 patients there should be 7 staff. Therefore, the hospital failed to staff the unit according to the approved staffing matrix.

On 06/14/2023 day shift, a beginning of shift census of 24 patients. Further review revealed a total of 5 staff assigned to the unit. Review of the matrix revealed for 24 patients, there should be 7 staff. Therefore, the hospital failed to staff the unit according to the approved staffing matrix.

On 06/19/2023 day shift, a beginning of shift census of 24 patients. Further review revealed a total of 5 staff assigned to the unit. Review of the matrix revealed for 24 patients there should be 7 staff. Therefore, the hospital failed to staff the unit according to the approved staffing matrix.

On 06/20/2023 day shift, a beginning of shift census of 23 patients. Further review revealed a total of 5 staff assigned to the unit. Review of the matrix revealed for 23 patients there should be 7 staff. Therefore, the hospital failed to staff the unit according to the approved staffing matrix.

On 06/21/2023 day shift, a beginning of shift census of 23 patients. Further review revealed a total of 5 staff assigned to the unit. Review of the matrix revealed for 23 patients there should be 7 staff. Therefore, the hospital failed to staff the unit according to the approved staffing matrix.

In an interview on 06/27/2023 at 1:05 p.m. and after reviewing the approved staffing matrix in the "Nursing Service" policy and procedure, S1ADM verified for a census of 23-24 patients there should be 7 staff.