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MEDICAL CITY PLANO 3901 W 15TH ST PLANO, TX 75075 Sept. 11, 2019
VIOLATION: STAFFING AND DELIVERY OF CARE Tag No: A0392
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on record reviews and interviews, the facility failed to ensure nursing service had adequate number of licensed registered nurses and other staff personnel for each department or nursing unit that was immediately available to provide patient care when needed in that:

The facility failed to provide timely MRI head /brain examination as ordered.

This failure placed the patient at an increased risk of harm/potential by not getting prompt diagnosis and treatment/care.

Findings included:
Patient #1 is a [AGE]-year-old female who presented to the Emergency Department via an EMS transfer for a possible middle cerebral artery occlusion on 03/06/19 at 08:19 a.m. Patient had a MRI (Magnetic resonance Imaging) of head/brain ordered by the physician at 11:16 a.m. The MRI exam was done the following day on 03/07/19 at 01:38 a.m. This was more than 14 hours after the exam had been ordered.
Physician order record reviewed on 09/10/19 at 09:45 a.m. indicated MRI exam was ordered at 11:16 a.m.
Records reviewed indicated MRI pre-procedure history questionnaire was completed on 03/06/19 at 0844.
Interview with the Staff # 2 and Staff # 3 on 09/10/19 revealed the MRI screening form was never faxed to the radiology department but was "handed" to the Technician. Staff #2 reported MRI technician called the nurse at NSICU on 03/06/19 at 3:30 p.m. and requested patient to be brought in for the examination. Staff #2 said the nurse reported "was not ready until 1700." Staff #2 reported MRI technician called again at 1700 and the nurse was "not available."
Nurses entry notes reviewed on 09/10/19 indicated the nurse called MRI technician on 03/06/19 at 1938 and requested to know if the patient was on the list to be scanned by the MRI technician. The MRI technician stated "No I don't see this patient on my list. I don't know about the screening form ....it will be another two hours." Nurses notes indicate the nurse called again MRI technician at 2129 and was told "It will be a while longer and I have not checked for the form, but I will after I am done with this patient."
Interview with Staff # 3 on 09/11/19 at 11:25 a.m. she reported they realized MRI technicians were able to view the worklist from the MRI scanner. She said, "we will educate all staff on this feature." Staff # 3 said "an app will be added to the current computer where we can track our eMAR's on." She said, "through this investigation today we have found several tools that will improve our communication in the department and nursing floors." She said the facility had no current Radiology Staffing Plan that reflect the actual hospital image. Staff # 3 said it was in progress of being revised.
Interview with the Staff # 4 on 09/11/19 at 1:45 p.m. revealed she was the Director NSICU. She stated the nurses in NSICU om 03/06/19 were caught up in a situation "there was a patient that required intubation and others who were 'crashing."
Review of facility policy titled "Prioritization of Imaging Services Exams" with an effective date 06/2019 stated "Radiology will perform all routine orders within eight hours of the origination of the request or order as appropriate/necessary, unless designated for a specific time."
Review of facility NSICU Scope and Staffing Plan revised 12/24/2018 stated "Patients waiting to be admitted or transferred to unit ...when staff is unable to meet demand/acuity - Manager and director will be notified. Call in PT and FT staff for extra shifts, utilize SRT, offer bonus as appropriate, utilize contract labor, unit educator in staffing. NM/ANM/CN/House Supervisor to notify director and NM of staffing shortage and patient holding."