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Based on review of documentation and interview, it was determined that facility nursing staff failed to notify the attending physician of a change in patient status.

Findings were:

Facility policy entitled " Physician Notification of Changes in Patient Condition and Care " stated in part, " For any patient, for the duration of the hospital stay, the nurse caring for the patient should notify the attending physician and any consultants for patient care and orders related to the following:
1. Any deterioration in the patient ' s status. "

Review of the Texas Nurse Practice Act 217.11, Standards of Nursing Practice, states, in part,
" (1) Standards Applicable to All Nurses. All vocational nurses, registered nurses and registered nurses with advanced practice authorization shall:
(A) Know and conform to the Texas Nursing Practice Act and the board's rules and regulations as well as all federal, state, or local laws, rules or regulations affecting the nurse's current area of nursing practice;
(B) Implement measures to promote a safe environment for clients and others;
(C) Know the rationale for and the effects of medications and treatments and shall correctly administer the same;
(D) Accurately and completely report and document:
(i) The client's status including signs and symptoms;
(ii) Nursing care rendered;
(iii) Physician, dentist or podiatrist orders;
(iv) Administration of medications and treatments;
(v) Client response(s); and
(vi) Contacts with other health care team members concerning significant events regarding client's status; "

Patient #1 was admitted to Lakeway Regional Medical Center during the evening of 3/23/15. At 8:20 am on the morning of 3/24/15, Staff Member #5 (RN) assessed the patient and reported " patient right arm decreased strength, range of motion, this arm has decreased sensation, right leg decreased rom/strength. " There is no documented evidence to indicate that the change in the patient ' s condition was reported to his attending physician. The change in status was not addressed until the attending physician made rounds at 11:45 am that same morning and noticed a " facial droop. "

In an interview with the Quality Analyst/RN on 8/2/16, it was acknowledged that the RN in the above scenario should have alerted the attending physician after discovering a change in patient status.