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MEDICAL CITY PLANO 3901 W 15TH ST PLANO, TX 75075 March 19, 2013
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
Based on record review and interview, the registered nurse (RN) did not supervise and evaluate the nursing care for 1 of 6 patients (Patient #1) who experienced an abnormally low pulse rate of 32 beats per minute on 08/29/12 at 11:03 AM.

Findings included:

Patient #1 was admitted as an in-patient the morning of 08/29/12 for "worsening of back and flank pain." At 11:03 AM, the following vital signs were obtained: "Temperature-96.9, Blood Pressure-103/65, Pulse-32, Respirations-20, and O2 Sat %: 98." There was no evidence in the medical record that the RN performed interventions to resolve the abnormally low pulse problem.

In an interview on 03/19/13 at approximately 1:30 PM in the conference room, Personnel #12, the facility's Clinician/ Educator, in the presence of Personnel #4 (Nurse Manager, Medical-Surgical/Oncology), was informed of the above findings and was asked what she would have done. She replied "I will notify the physician" immediately and assess if the patient was symptomatic. She stated if the patient was not symptomatic she will check the patient's position and/or the blood pressure cuff then retake the blood pressure.

Policy: "Assessment/Reassessment of Patients" revised 06/2011 "Purpose: 1. To provide guidelines for each discipline's role in assessment of the patient's status and determine the need for individualized care/treatment/services...4. To determine the need for further assessment based on patient's diagnosis..."

Nursing Assessment Guidelines the facility adopted from the book authored by "Lippincott, Williams, & Wilkins - Pulse Assessment" reviewed on 10/06/12 reflected the normal pulse rate for an adult was "60-100 beats/minute."