The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.
|H LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE I||12902 MAGNOLIA DR TAMPA, FL||Oct. 11, 2011|
|VIOLATION: RN SUPERVISION OF NURSING CARE||Tag No: A0395|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on record review, staff interview and review of hospital policies and procedures, it was determined the facility failed to provide nursing supervision for 2 of 10 patients (#'s 2, 5) to ensure timely reassessment and interventions related to pain management to meet the patient's care needs. Failure to provide nursing care based on timely reassessments places patients at risk of not receiving care and services to prevent injury or harm.
1. Review of patient #5's medical record revealed the patient was admitted to the facility on [DATE] with a diagnosis of [DIAGNOSES REDACTED][DIAGNOSES REDACTED] Resection. A Physician's order dated 10/5/11 for Dilaudid Patient Care Analgesic (PCA) 0.2mg q 5 min with maximum of 4mg PRN was confirmed. The PCA was initiated in Post Anesthesia Care Unit (PACU) and the patient was transported to 5South from PACU. A Nursing assessment was completed on arrival to 5South. A care plan was initiated on admission which included Acute Chronic Pain, with interventions documented as Dilaudid PCA and repositioning. A Nursing patient assessment was documented at the beginning of each shift and included pain assessment during patients hospital stay.
Medical record review revealed the patient was not assessed or reassessed for pain every 4 hrs, as per hospital policy while patient was using PCA. Hospital policy P-13 effective 4/2011, Patient Controlled Analgesia Delivery (PCA), Non-Epidural (NERVE BLOCKS) indicated an assessment of the patient will be at no greater than 4 hr intervals. If at any time the pain rating is greater than 4 on a scale of 2 to 10, then reassessment will be made at an interval of no greater than 2 hrs of intervention.
A Physician's order dated 10/9/11 at 1100, ordered to discontinue PCA pump, Percocet 1-2 tabs by mouth (po) every 4 to 6 hrs as needed (PRN). Medication Administration Record shows Percocet was given on 10/9/2011 at 1255 and 2343. No pain assessment or reassessment documentation was found. The Medication Administration Record shows Percocet given 10/10/2011 at 0500, with no pain assessment documentation before administration of Percocet.
Interview with Fern Rhinesmith, RN Nurse Manager of 5S confirmed that pain assessment should be documented on nursing flow sheet by nurse and also each shift assessment should include a pain assessment and reassessment for pain every four hours.
2. Review of patient #2's medical record revealed the patient was admitted for surgery on 4/8/11. The patient had an epidural catheter placed during the surgery for post operative pain control. Review of the nursing documentation revealed the patient had good pain control and was out of bed to the chair and ambulating around the nurse's station beginning on 4/10/11. On 4/12/11 the epidural was discontinued and a Morphine PCA was initiated per physician orders.
Review of the facility's policy, "PCA, Non-Epidural/Nerve Blocks", effective 4/2011, requires assessment of the patient to be no greater than 4 hour intervals. Review of the nursing documentation on 4/12 and 4/13 on the day shift (7:00 am to 7:00 pm) revealed the patient was assessed once during the day shift and not every four hours as required by the facility's policy.
Interview on 10/11/11 at 2:45 p.m. with the nurse manager confirmed the above findings.