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.
|TAMPA GENERAL HOSPITAL||1 TAMPA GENERAL CIR TAMPA, FL 33606||Sept. 20, 2018|
|VIOLATION: RN SUPERVISION OF NURSING CARE||Tag No: A0395|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on record review, policy review, and staff interview it was determined the facility failed to ensure a registered nurse evaluated the care for each patient upon admission and when appropriate on an on-going basis in accordance with accepted standards of nursing practice and hospital policy for two (#3 & #7) of seven sampled records.
According to the facility policy titled Plan of Care for Emergency Department, effective 04/2004 and reviewed 12/2014, all patients in the emergency department will be assessed based on the patient's complaint and/or signs and symptoms and assigned a severity level. The system used for the assignment of the severity level is the Emergency Nurse Association 5-tiered Emergency Severity Injury (ESI) Triage System. The following vital sign and nursing assessment/reassessment time frames are established based on the ESI
ESI Level 1: Every 15 minutes until stable and revaluate change acuity level if indicated
ESI Level 2: Every 20 minutes for the first hours and then every hour
ESI Level 3: Every 3-4 hours
ESI Level 4: Every 4-5 hours
ESI Level 5: Upon discharge
ESI Level 1 & 2: Every 2 hours a focused assessment is to be documented
ESI Level 3 & 4: Every 3-4 hours a focused assessment is to be documented
ESI Level 5: Within 30 minutes of the patient being discharged
A review of the facility form titled AVS report within the medical record of Patient #7, revealed that the patient came to the facility emergency department as a walk-in on 06/19/18 at 4:44 p.m. at the advice of her personal physician for abnormal laboratory values. Patient #7 was triaged at 4:47 p.m. with vital signs and a nursing assessment being completed at that time. This patient was determine to be an ESI Level 2 patient. The patient was placed in a "quiet room" on 09/19/18 at 5:31 pm., while awaiting the ED physician.
At 6:30 p.m., the next set of vital signs for Patient #7 were checked and documented in the medical record by the emergency patient care technician (PCT). Patient #7 left the facility at 6:59 p.m., 4.25 hours after arriving, without being seen at all by a physician and not being seen or assessed again by nursing. On 06/19/18 at 7:36 p.m., the assigned registered nurse entered a note in the medical record of Patient #7 stating the PCT informed the nurse that the patient could not wait any longer and left at 6:59 p.m.
After reviewing the medical record of Patient #7, the manager of ED confirmed, during an interview on 09/20/18 at 12:15 p.m., that this patient was made a Level 2 because the patient had a history of kidney transplant and due to reports from the patient that the patient had abnormal laboratory results according to the patient's physician. The manager confirmed that the Level 2 assignment was correct.
The facility failed to reassess Patient #7 according to facility policy Plan of Care for Emergency Department. The condition of Patient #7 at discharge was not documented. This was confirmed with the manager of the Emergency Department.
A review of the facility form titled AVS report within the medical record of Patient #3 revealed that the patient came to the facility emergency department as a walk-in on 04/12/18 at 4:35 p.m. for complaints of joint pain. The medical record of Patient # 3 included a history of [DIAGNOSES REDACTED]. At 4:40 p.m., Patient #3's vital signs were taken and at 5:03 p.m., the patient was triaged and a nursing assessment was completed. This patient was determine to be an ESI Level 2 patient. The patient was placed in a waiting area at 5:06 pm., while awaiting an ED room and physician exam.
The assigned registered nurse entered a note in the medical record of Patient #3 stating the patient left without being seen on 04/12/18 at 9:40 p.m., 5 hours after the first and only set of vital signs were obtained.
There is no further documentation in the medical record that Patient #3 was ever seen by a physician or by nursing staff again.
The facility failed to reassess Patient #3 according to facility policy. The condition of Patient #3 at discharge was not documented. This was confirmed with the Risk Management Specialist.