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MERCY REGIONAL MEDICAL CENTER 800 E MAIN VILLE PLATTE, LA 70586 Oct. 30, 2015
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
Based on record reviews, observations and interviews, the hospital failed to ensure the registered nurse supervised and evaluated the nursing care of each patient as evidenced by failing to assign a staff member with the primary responsibility of monitoring the Medical Surgical telemetry patients who were remotely monitored in the ICU.This was evidenced by nurses in the ICU being assigned as the primary nurse of ICU patients as well as being assigned monitoring of telemetry patients on the Medical Surgical Unit. This deficient practice had the potential to affect 4 (#1-#4) of 4 (#1-#4) current Medical Surgical patients on telemetry monitoring.

Findings:

Review of the hospital policy titled Telemetry Monitoring, last revised 4/2015, revealed in part:
Policy: Telemetry is a means of monitoring a patient's cardiac rhythm; Telemetry monitoring is available on the Medical and Surgical nursing units; Continuous telemetry monitoring is performed in the ICU at this offsite campus; The heart pattern will be received at the nurses' station for observations and documentation; In the event of a significant dysrhythmia, the nurse will document the strip and notify the physician.

Review of the hospital census for 10/28/15, presented as current by S1CNO, revealed Patients #1,#2,#3 and #4 were Medical Surgical patients being monitored by Telemetry. Further review revealed a census of 2 patients (#5, #6) in the Intensive Care Unit.

Review of the medical records for Patients #1-#4 revealed printed telemetry monitoring documentation of rhythm strips for all 4 of the Medical Surgical patients currently being monitored remotely in the ICU.

In an observation on 10/28/15 at 11:45 a.m., 2 telemetry monitors were noted in the ICU nurse's station. Patient #5 (ICU) and Patient #6 (ICU) were being monitored on one screen and Patients #1- #4 (Medical-Surgical Patients) were being remotely monitored on a second screen located beside the 1st screen. Further observation revealed S4RN and S5RN were both looking at computer screens. No ICU staff was noted to be observing the Telemetry Screens. S5RN was then observed leaving the nurses ' station and entering a patient room. S4RN was also noted to leave the ICU nurses ' station leaving no one to monitor the telemetry patients. No ICU staff was noted to be continuously monitoring the telemetry patients during the observation which lasted approximately 10-15 minutes.

In an interview on 10/28/15 at 11:50 a.m. with S3AsstCNO, she confirmed the screen with 4 patients was the screen where the Medical Surgical telemetry patients were being monitored remotely in the ICU. S3AsstCNO confirmed there were 2 RNs (S4RN and S5RN) and 2 current inpatients (#5 and #6) in the ICU at the time of the observation. She indicated the ICU was staffed at a 2:1 ratio. She further indicated the ICU nurses were responsible for both their primary assigned patients and for monitoring the Medical Surgical telemetry patients. She also confirmed there was no dedicated staff on the Medical Surgical floor assigned sole responsibility for monitoring the Medical Surgical telemetry patients.

In an interview on 10/28/15 at 11:59 p.m. with S6LPN (Medical Surgical Unit), she indicated 4 (#1-#4) of the 15 current inpatients on the Medical Surgical unit were on telemetry. She confirmed the above referenced patients were being monitored remotely in the ICU by the ICU nursing staff.

In an interview on 10/28/15 at 3:10 p.m. with S2CNO, she indicated the ICU nurses were responsible for caring for their primary assigned patients and for remote monitoring of the Medical Surgical telemetry patients. She indicated the main campus had telemetry technicians who were solely responsible for monitoring of the patients on Telemetry. She confirmed the offsite campus did not utilize telemetry technicians for monitoring of telemetry patients.

In an interview on 10/29/15 at 11:20 a.m. with S8Quality, she confirmed the ICU nurses had a patient assignment in addition to the responsibility of remotely monitoring the Medical Surgical telemetry patients. She agreed there was a potential for lapses in continuous monitoring of Medical-Surgical telemetry patients if the nursing staff in the ICU was busy at the bedside of their assigned patients. She also confirmed there was no assigned staff on the Medical-Surgical floor solely responsible for monitoring the Medical Surgical telemetry patients.

In an interview on 10/29/15 at 3:22 p.m. with S9LPN, she indicated she has been pulled to work ICU. S9LPN also indicated that when there were just 2 nurses in the ICU and both of them had to respond to their patients the telemetry monitor had gone unobserved by staff. She further indicated there is no guarantee that the nurses or staff on the Medical Surgical floor is monitoring the telemetry patients because there was no way for them, in the ICU, to know if anyone was in the nurses ' station.

In an interview on 10/30/15 at 9:47 a.m. with S10RN, she confirmed she works in the ICU. She also confirmed the ICU nurses were responsible for caring for their primary assigned patients and for monitoring the telemetry patients from the Medical Surgical floor. She indicated the ICU did not have a dedicated staff assignment for telemetry monitoring. She confirmed there are occasions where the ICU nursing staff had not been observing the telemetry monitors and it had been a concern for a long time.