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.

UNITED HEALTH SERVICES HOSPITALS, INC 10-42 MITCHELL AVENUE BINGHAMTON, NY 13903 May 5, 2016
VIOLATION: EMERGENCY SERVICES POLICIES Tag No: A1104
Based on findings from document review, medical record (MR) review and interview, the facility did not ensure that all patients received care according to its policies and procedure (P&P) and current standards of practice related to vital sign monitoring for 1 of 11 patients, Patient #1.

Findings include:

-- The hospital P&P titled "Intravenous Thrombolytic Therapy for Acute Ischemic Stroke- TPA (tissue plasminogen activator)," last revised 2/2014, indicated that nursing staff should obtain initial vital signs (blood pressure (BP), pulse (P), respirations (R), oxygen saturation (O2 Sat) initially at the beginning of a TPA infusion and then at least every 15 minutes for 1 hour duration, then every 30 minutes for 6 hour duration and then hourly for 16 hours.

-- Review of Patient #1's MR revealed that the patient presented to the emergency department (ED) on 2/27/16 with chief complaint of acute mental status change. At 20:36 (time of triage) vital signs were obtained: BP 167/76, P 77, R 22, O2 Sat 96 %. A hospital stroke response was activated. Patient A underwent diagnostic testing which included CT angiogram (CTA) Head which showed a large ischemic area in the left parietal lobe consistent with distal middle cerebral artery (MCA) occlusion. At 21:41, Staff A ordered Alteplase (TPA) 6.6 mg intravenously (IV) bolus once followed by 59.1 mg IV infusion over 1 hour. At 22:02 Staff B documented administration of Alteplase bolus (6.6 mg) and at 22:07, initiation of Alteplase 59.1 mg infusion over 1 hour. At 23:03, Patient #1's vital signs were: BP 145/73, P 72, R 16, O2 Sat 97%. Patient #1 remained in the ED until 00:30 on 2/28/16 and was then transported to the intensive care unit. There is no documentation in the MR indicating that Patient #1's vital signs were obtained every 15 minutes during the TPA infusion and every 30 minutes thereafter while in the ED, per hospital P&P.

--During interview of Staff C on 5/5/16 at 14:30, the above finding was acknowledged.