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.

Intakes: TN 611

Based on observations, interviews and review of personnel records, it was determined the facility failed to ensure all staff providing nursing care under the supervision of a Registered Nurse (RN) were qualified to perform nursing duties.

The findings included:

Observations on 4/5/11 at 8:45 AM at the nursing desk in the post-operative area of the surgical unit revealed a paramedic was working in the area. In an interview at the time of the observation, the Paramedic stated her job duties in this area included checking vital signs, starting IV's [inserting intravenous cannulas] and anything she was asked to do within her scope of practice.

In an interview on 4/5/11 at 1:45 PM in the ambulance bay, an Emergency Medical Technician trained for Intravenous infusion (EMT-IV) stated the paramedics and EMTs who work with the hospital's Emergency Medical Service are called to the hospital to assist with lifting heavy patients or "when they have trouble starting IV's." He stated they may be called more than once a shift, or not called for several days, "Basically, we were told since the ambulance service is owned by the hospital, we are to go help when they need us; nothing outside our scope of practice."

In an interview on 4/5/11 at 9:00 AM in the conference room, the Director of Nursing (DON) stated Paramedics are used to come start IV's in the hospital if nursing is unable to get an IV started, respond to codes in the emergency room , respond to assist with violent patients and sit with suicidal patients. She stated, "They are not allowed to touch patients, they know what's in their code of conduct and they tell us what they are and are not allowed to do." She further stated there is one paramedic that works in the ER as needed and occasionally works in surgery.

Review of the job description for the paramedic observed working in the post-op area revealed, "JOB TITLE: ER [emergency room ] Paramedic, DEPARTMENT: Nursing, SUPERVISOR: Nursing Supervisor/Nurse Executive... POSITION SUMMARY: ...The ER Paramedic may provide routine care in accordance with the established policies and procedures of [named hospital] and as directed by the Nurse Supervisor, Nurse Executive and Paramedic to assure the highest degree of quality patient care is given and maintained at all times... SCOPE OF RESPONSIBILITY: To assist in direct patient care under the supervision and direction of a R.N. ... IMPORTANT: This job description is not intended to be all-inclusive; an employee will also perform other reasonably related job responsibilities as assigned by immediate supervisor and other management as required. This organization reserves the right to revise or change job duties as the need arises..."