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.
|THE HOSPITALS OF PROVIDENCE - SIERRA CAMPUS||1625 MEDICAL CENTER DR EL PASO, TX 79902||June 18, 2020|
|VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING||Tag No: A0144|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on a review of documentation and interview, the facility failed to ensure the right to care in a safe setting by failing to document monitoring patients at the level ordered by the physician.
Facility based policy entitled, "Constant Observer Assessment, Implementation and Discontinuation" stated in part,
The Hospital recognizes that Constant Observers may be utilized in order to provide continuous
observation of a patient to support safety. The Hospital will use a clinical assessment approach to
determine clinically based assignment and implementation. The Hospital will have a process in
place to monitor constant observer usage to ensure appropriate assignment and management of
A. If an assessment reveals that a patient is a danger to self and/or others a constant observer will be implemented immediately. A constant observer at the bedside takes priority ...
The RN will assess the patient's physical condition, behaviors, and emotional status to determine
if constant observation of the patient is warranted to ensure patient's safety ...
e. Constant Observer is ordered by a physician, mid-level provider or qualified mental health professional for behavioral health (refer to Suicide Risk Assessment policy for definition) to meet
accreditation, licensing, federal, state and local statutes. Appropriate chain of command may always be implemented to meet the patient's needs ...
C. Ordering/Initiation of Constant Observer
1. If a physician, mid-level provider or qualified mental health professional (refer to suicide risk assessment policy for definition) order is obtained to meet accreditation, licensing, federal, state and local statute, the order will be time limited for 24 hours and must be renewed every 24 hours.
Appropriate chain of command may always be implemented to meet the patient's needs.
2. Hospital will have a policy and process in place for ordering constant observers, obtaining, assigning and discontinuing constant observers, to include an approval chain of command process.
3. A Constant Observer request form must be completed for the initial request and at least every shift until the patient assessment warrants discontinuation.
The form must include the following:
a. The order in which the Constant Observer role will be filled (e.g., from scheduled staff, overtime staff, pool staff, contract staff, etc.) ...
D. Implementation of Constant Observer ...
5. The Constant Observer will document patient observations every 15 minutes on the designated flow sheet as indicated and as instructed by the nurse."
Review of medical records revealed that of 5 of 6 patients had issues with
Review of Constant Observer Flowsheet for Patient #1 revealed the following:
*There was no Constant Observer flowsheet for 05/12/20 when the observations were initially ordered at 2017. - Order past change of shift. Constant observer assignment was initiated on 5/13 due to staffing. Nursing staff continued to monitor patient throughout.
*There was a Constant Observer flowsheet dated 05/13/20 that documented observation from 1115-0600, there was a missed observation at 2245. Also there was no documented observation from 0700-1115 on that date when the order was in place.
*Behind the Constant Observer Request Form dated 05/14/20, there was undated Constant Observer flowsheet with observations from 0700-1800 and 0600-0645 (it is unclear if this is a form for 05/14) and there was another flowsheet dated 05/14/20 with observation from 1800-0615. -
*Behind the Constant Observer Request Form dated 05/15/20, there was an undated Constant Observer flowsheet with observations from 0700-1800 and 0600-0645 (it is unclear if this is a form for 05/15). This form with no date was also missing observation from 1800-0600. The night shift was staffed the assignment was verified with Optilink staffing report.
*Behind the Constant Observer Request Form dated 05/16/20 there was no Constant Observer Flowsheet present. There were no flowsheets present dated 5/16/20. This date was staffed according to the Optilink staffing report, Constant Observer documentation flowsheet missing.
Patient #2 had orders for Constant Observer from 05/23/20 17:21 through 05/25/20 (discharged [DATE]).
*This patient had a Constant Observer flowsheet (no date, date marked 23:05) with observation from 2315-0615. Missing observations from 0630-0645.
*This patient had missing observation documentation on an undated form from 0630-0645. There was no flowsheet dated 05/23/20. There were no orders for constant observer on 05/26/20 and 05/27/20 despite flowsheets being completed.
Patient #4 had orders for Constant Observer from 04/28/20 at 0345 through 05/20/20 (discharged [DATE]).
*This patient had a Constant Observer flowsheet date 04/28/20 completed 0700-0645.
*The constant observer was ordered on [DATE] at 0345, but observations were not documented starting until 0700.
Patient #5 had orders for Constant Observer from 03/28/20 0010 through 03/29/20 (discharged [DATE]).
This patient had a Constant Observer flowsheet dated 03/28/20 completed from 0700-0645.
*Another flowsheet (no date, date marked 0600) with observation from 0700-1015 and 0600-0645. Missing observations from 1030-0545.
*There was no flowsheet dated 03/29/20 for this patient. If the flowsheet with the date marked 0600 is for the date of 03/29/20, the patient discharged on [DATE] so the 0600-0645 portion of the form should not have been completed.
Patient #6 had orders for Constant Observer from 04/27/20 at 1730 through 04/28/20 (discharged [DATE]).
*This patient had 2 Constant Observer flowsheet dated 04/28/20. One flowsheet dated 04/28/20 had observations from 2200-0645. The other sheet dated 04/28/20 had observations 0700-0645.
* A flowsheet for 04/29/20 had observations from 0700-1800 and 0600-0645. .
* There was no flowsheet for 04/27/20 the date the constant observer was initially ordered. There was no order for constant observer on 04/29/20 despite there being a flowsheet with this date. Also the patient discharged on [DATE] so the 0600-0645 portion of the form should not have been completed.
Based on the above review, it appears several Observer Flowsheets were not dated and/or were missing observations in the 24-hour coverage of these patients. According to the facility policy if on constant observer status there is to be documentation of patient observations every 15 minutes on the designated flow sheet. The facility failed to ensure this documentation as present for 5 out of 6 patients. Due to this fact it cannot be established that patient's were effectively monitored per policy.
The above findings were verified on 06/18/20 with staff member #1 via telephone call.