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.

CENTRAL TEXAS MEDICAL CENTER 1301 WONDER WORLD DRIVE SAN MARCOS, TX 78666 Aug. 15, 2017
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
Based on interview, and document review, the hospital failed to ensure an RN supervised and evaluated the nursing care for each patient on an ongoing basis in that 1 of 2 patients EMRs with multiple systolic blood pressure readings outside acceptable normal parameters were not reported to the unit nurse. The failure to report higher than normal systolic blood pressure readings to the nurse could result in potential medical deterioration of patients due to lack of more frequent blood pressure monitoring and patient assessment. The Senior Care unit staff did not follow the unit policy.

Findings included:

Review of patient #2 electronic medical record (EMR) was performed on the afternoon of 8/15/17. The review of the EMR vital sign record revealed a systolic blood pressure of 184 on 7/28/17 at 1530 and a diagnosis of hypertension documented by the emergency room physician. The documented blood pressure readings for 7/29/17 at 0815 was 188/78, at 0817 was 185/80. There were no documentation by the MHTs that nursing staff had been notified of the higher than normal systolic blood pressure results. There was also no documentation that nursing staff was aware of the higher than normal systolic blood pressure results.
In an interview with the Clinical Information Specialist, Staff #6 on the afternoon of 8/15/17, she confirmed the above findings.
Review of facility policy titled "VITAL SIGNS, Policy # 220-189, Policy Author: Senior Care Unit" with an effective date of "April 2017" stated in part "PROCEDURE 6. Any of the following vital sign reading will be reported to the staff or unit nurse immediately:
a. Resting pulse <60 or >80. Respirations <16 or > 20.
b. Blood pressure outside the following parameters:
95-160 systolic
60 - 90 diastolic"
VIOLATION: STAFFING AND DELIVERY OF CARE Tag No: A0392
Based on review of documentation and interviews with the facility staff the facility failed to provide adequate nursing staffing for the Senior Care Unit as 2 license nurses were schedule for 7pm shifts but only one register nurse worked on the 7pm shift for the month of June 2017.

Findings were:

Review of the SCU Staffing grid revised 4/25/17 revealed staffing for 7p-7a shift1 RN and 1 LVN for census of 1-13 patients. At the time the surveyor was reviewing the staffing and assignments sheets an interview was conducted with staff #2 CNO in the conference room on the afternoon of 8/15/17 in the presence of both surveyors staff #2 stated they do not use LVN's it should be RN's.

Review of the assignment sheets revealed SCU was not staffed according to the staffing grid. June 1-30, 2017 7p-7a assignments stated only 1 RN worked with 1-2 MHT per shift during the month of June. The staffing grid states 1 RN and 1 LVN 7p-7a each shift. MHT'S are added according to the census.

In an interview with staff #7 in the conference room on 8/15/17 the findings were confirmed.