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METROSOUTH MEDICAL CENTER 12935 S GREGORY BLUE ISLAND, IL 60406 April 27, 2017
VIOLATION: NURSING SERVICES Tag No: A0385
Based on document review and interview it was determined that the Hospital failed to ensure proper nursing supervision and assessment of all telemetry unit patients going off of the unit for tests. This potentially affects all 38 patients remotely monitored on the the 4 North and 4 South unit census from 4/27/17.

As a result the Condition of Participation CFR 482.23 Nursing Service was not met.

Findings include:

1. The Hospital failed to ensure the patients on remote telemetry, that were transported off the unit for tests, were properly assessed and the assessments were documented as required.
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on document review, observation, and interview it was determined for 4 of 4 (Pt #1, 11, 12, and 13) clinical records reviewed of patients transported to procedures performed off the unit, the Hospital failed to ensure the patients were assessed and the assessment documented as required. This could potentially affect all 38 patients on remote telemetry on 4/27/17.

Findings include:

1. Hospital policy entitled, "Remote Telemetry Monitoring Care of Patients," (revision date 9/22/16) required, " ...Documentation for patients off the Telemetry Unit: 1. The following will be documented by the patient's nurse into the patient's medical record: a. Date and time of departure and return to the unit; b. How the patient was transported; c. Equipment used ...Any dysrhythmias ...include rhythm strips from the monitor and documentation to include the patient has been transported ..."

2. The clinical record of Pt #1 was reviewed on 4/27/17 at approximately 9:45 AM. Pt #1 was a [AGE] year old female admitted on [DATE] from the emergency department (ED) at 3:10 AM, with diagnoses of [DIAGNOSES REDACTED].1; pulse 97; respirations 26; blood pressure 145/73; and oxygen saturation 93% with a triage level of 3 out of 5. Pt #1 was admitted to North at 8:50 AM with diagnoses of [DIAGNOSES REDACTED]

Nursing documentation dated 3/15/17 at 1:33 PM included Pt #1 an Echocardiogram.

Pt #1's clinical record contained a Resuscitation Record dated 3/15/17 at 1:16 PM which indicated that a Code Blue was initiated and that Pt #1 expired at 2:01 PM.

Nursing documentation dated 3/15/17 at 4:58 PM included, "Went into room and found patient lying on stomach with leg out of bed, patient unresponsive and called rapid response ...code blue called."

Pt #1's clinical record did not include nursing documentation indicating Pt #1's time of transportation to the Echo department, how Pt #1 was transported, the cardiac rhythm when Pt #1 left, when she returned, and/or the rhythm upon return.

2. On 4/27/17 at approximately 9:10 AM, the nurse preceptor (E #10) was interviewed. E #10 stated that she did not check the monitor on 4 north before Pt #1 was transported to the ECHO department.

3. On 4/27/17 at approximately 9:15 AM, the nurse orientee (E #11) was interviewed and stated that she did not check the rhythm of Pt #1 on the unit's monitor prior to leaving the unit.

4. On 4/27/17 at approximately 9:45 AM, the Chief Quality Officer (E #1), Director of Med/Surg/Tele (E #2), and the Director of Risk Management (E #13) were interviewed. E #13 stated that the nurses should have best practice for documentation, and E #2 stated that the nurses should have assured the documentation was in the chart. E #2 stated that the nurse is ultimately responsible for the patient.

4. The clinical record of Pt #11 was reviewed on 4/27/17 at approximately 10:00 AM. Pt #11 was a [AGE] year old female admitted on [DATE] with a diagnosis of [DIAGNOSES REDACTED]'s order dated 4/24/17 that required telemetry. Documentation dated 4/26/17 included Pt #11 left the unit and had an electroencephalogram. The clinical record lacked documentation of Pt #11 leaving the unit, how the patient was transported, the cardiac rhythm of Pt #11 when leaving and returning to the unit, and when the patient returned.

5. The clinical record of Pt #12 was reviewed on 4/27/17 at approximately 10:10 AM. Pt #12 was a [AGE] year old female admitted on [DATE] with diagnoses of [DIAGNOSES REDACTED]'s order dated 4/20/17 that required telemetry. Documentation dated 4/24/17 included Pt #12 left the unit and had a pulmonary perfusion and ventilation test. The clinical record lacked documentation of Pt #12 leaving the unit, how the patient was transported, the cardiac rhythm of Pt #12 when leaving and returning to the unit, and when the patient returned.

6. The clinical record of Pt #13 was reviewed on 4/27/17 at approximately 10:20 AM. Pt #13 was an [AGE] year old male admitted on [DATE] with a diagnosis of [DIAGNOSES REDACTED]'s order dated 4/2/17 that required telemetry. Documentation dated 4/26/17 included Pt #13 left the unit and had aThoracentesis with imaging performed. The clinical record lacked documentation of Pt #13 leaving the unit, how the patient was transported, the rhythm of Pt #13 when leaving and returning to the unit, and when the patient returned.

7. During interviews on 4/27/17 at approximately 11:30 AM, E #1 and E # 2 stated that the clinical records did not contain the documentation of the patients leaving the unit, returning to the unit, or their cardiac rhythms.