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.

NASH GENERAL HOSPITAL 2460 CURTIS ELLIS DRIVE ROCKY MOUNT, NC 27804 June 25, 2015
VIOLATION: BLOOD TRANSFUSIONS AND IV MEDICATIONS Tag No: A0409
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of hospital policy, medical record review and staff interviews, the nursing staff failed to monitor a patient receiving a blood transfusion per hospital policy for 2 of 3 patients reviewed (Patient #6 and 10).

The findings include:

Review of the hospital's policy #PC 210.78 - Blood/Blood Products/Blood Derivatives Administration, revised 8/6/14, revealed, "...B. Administration & Monitoring of Blood (Leukoreduced Red Blood Cells), Fresh Frozen Plasma (FFP) & HLA Products 1. Obtain baseline vital signs within one hour prior to hanging blood ....12. Monitor and record vital signs (TPR & BP) (temperature, pulse, respirations, and blood pressure) during the transfusion as follows: a. 15 minutes after starting the infusion, b. every hour, c. at discontinuation, d. one hour after completion ..."

1. Closed medical record for Patient #6 revealed an [AGE] year old female admitted [DATE] with diagnosis of pneumonia. Record review revealed physician orders on 5/31/2015 to transfuse one unit of packed red blood cells. Review revealed the blood was started 5/31/15 at 1627. Record review revealed vital signs (temperature, pulse, respirations, and blood pressure) were taken at 1549, 1645, 1745, and at 1924 - when the transfusion was completed. Review revealed no vital signs taken between 1745 and 1924 (1 hour 39 minutes).

Interview on 06/24/2015 at 1630 with Administrative Nursing Staff #2 confirmed the nurse did not assess vital signs (temperature, pulse, respirations and blood pressure) every hour while administering blood to Patient #6 per the hospital's policy.

2. Closed medical record for Patient #10 revealed a [AGE] year old female admitted [DATE] with diagnosis of pregnancy at term and repeat cesarean section. Record review revealed physician orders on 5/14/15 to transfuse two units of packed red blood cells. Review revealed the patient's vital signs were documented 5/14/15 at 1138 and the first unit was started at 1305 (1 hour 27 minutes prior to initiating the transfusion).

Interview on 06/24/2015 at 1630 with Administrative Nursing Staff #1 confirmed the nurse did not assess vital signs (temperature, pulse, respirations and blood pressure) within one hour prior to administering blood to Patient #10 per the hospital's policy.