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.

ASCENSION ST JOHN MEDICAL CENTER 1923 SOUTH UTICA AVENUE TULSA, OK 74104 Dec. 7, 2016
VIOLATION: PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT Tag No: A0145
Based on document review and interview the hospital failed to protect patients from neglect.

Findings:
Review of 5 incontinent-patient charts showed that persons known to be incontinent of urine and/or stool were to be checked for incontinence (clean and dry), and turned in bed, at two (2) hour intervals. The charts further showed that patients were visited by staff but the assessments for incontinence and/or turning were not addressed, in the charts, as being done on each of those visits. In 4 of 5 patient charts the timing of notes concerning incontinence checks and/or turning the patient were as much as 5 hours apart. Interviews with Nursing Program Specialist, Quality Accreditation Manager, and Informatics nurse concurred that the charts showed excessive time between incontinence checks and positioning/repositioning notes.

The Nursing policy named "Assessment/Reassessment" does not describe which specific details comprise assessments or reassessments. No mention is made of hands-on physical assessment or notations of such things as skin condition, including bed-sores, vital signs, continence/incontinence, respiration, circulation, or other specific items of possible concern. The Nursing Program Specialist and Quality Accreditation Manager verified that no such language is contained in the policy.

Skin assessments for 1 of 2 patients was limited to "Braden Scale" comments and ratings. No instance of visualization of the skin, including existing or new skin abnormalities, was documented at any point in the patient chart including assessments either initial assessment or at patient discharge.
On the 2nd patient, a skin visualization note was made at initial assessment. However, all other assessment notes, including at patient discharge, were limited to "Braden Scale" comments and ratings. The Nursing Program Specialist concurred with the fact that "Braden Scale" ratings were used as skin assessments.
(Note: Braden scale is to classify RISK of skin damage. It does not indicate current problems)
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
Based on interview and record review the hospital failed to ensure that a registered nurse was properly evaluating the care of each patient.

Finding:
Review of 5 incontinent-patient charts showed that persons known to be incontinent of urine and/or stool were to be checked for incontinence (clean and dry), and turned in bed, at two (2) hour intervals. The charts further showed that patients were visited by staff but the assessments for incontinence and/or turning were not addressed, in the charts, as being done on each of those visits. In 4 of 5 patient charts the timing of notes concerning incontinence checks and/or turning the patient were as much as 5 hours apart. Interviews with Nursing Program Specialist, Quality Accreditation Manager, and Informatics nurse concurred that the charts showed excessive time between incontinence checks and positioning/repositioning notes.