HospitalInspections.org

Based on observation, interview, record review and policy review, the hospital failed to ensure that monitor technicians were properly trained.

Findings included:

1. Review of the hospital's undated document titled, "Job Description-Monitor Technician," showed that the monitor technician would be responsible for the continuous monitoring of patient's cardiac rhythms, communication with nursing and respiratory staff, maintain telemetry (remote observation of a person's heart rhythm, using signals that are transmitted from the patient to a computer screen) documentation, monitor patients in rooms with video cameras, and always remain at the monitor.

Review of the hospital's document titled, "Patient Care-Telemetry: Cardiac Monitoring," revised 08/2020, showed that the patient's cardiac rhythm strip should be recorded, analyzed, reviewed, and verified by the nurse and the monitor technician each shift by initialing the rhythm strip.

Review of the hospital's document titled, "Clinical Competencies," reviewed 10/2020, showed that Monitor Technician Competencies included:
- Completion of a basic arrhythmia (irregular heartbeat) course during initial orientation with a minimum score of 80%.
- If the staff member scored less than 80% the test would be reviewed, along with additional educational material.
- A second test must be successfully passed within seven days.

Review of the hospital's document titled, "Quality Assurance and Performance Improvement (QAPI, process for reporting and/or identifying adverse events, near misses or review of high risk, problem prone areas for patient safety) Committee Report-Human Resources," dated 10/05/21, showed that hospital staff should complete and turn in their competency checklist to their department manager during their 90 day evaluation meeting.

Review of untitled, undated spreadsheet attached to the hospital's document titled, "QAPI Report-Human Resources," showed that Staff A's competencies were not due until 12/23/21.

Review of Staff A's personnel file, on 10/13/21 at 1:00 PM, showed that she had not completed any electrocardiogram (ECG or EKG, test that checks for problems with the electrical activity within the heart) or cardiac rhythm identification classes since her start date of 09/23/21.

Observation on 10/12/21 at 2:15 PM, showed Staff A, Monitor Technician, completing the screening of the State Agency (SA) survey team for entrance to the hospital along with her telemetry duties.

Observation on 10/12/21 at 3:55 PM, showed Staff A, Monitor Technician, seated at the nursing station watching the telemetry and video screens, along with answering incoming phone calls to the hospital.

During an interview on 10/12/21 at 3:55 PM, Staff A, Monitor Technician, stated that:
- She had just started at the hospital as the monitor technician and would be attending orientation on 10/13/21.
- She had not taken any type of rhythm analysis or competency test prior to her first shift.
- She used to be a monitor technician in 2013, but had most recently been a pharmacy technician.
- She had been orientated to the monitor system by a staff Licensed Practical Nurse (LPN).
- She was responsible for monitoring the cardiac rhythms of all patients on telemetry, watching the video monitors of the patients in specific rooms, and screening any individuals entering the hospital for signs and symptoms of COVID-19 (highly contagious, and sometimes fatal, virus).

Review of untitled, undated spreadsheet attached to the hospital's document titled, "QAPI Report-Human Resources," showed that Staff A's competencies were not due till 12/23/21.

Review of Staff A's personnel file, on 10/13/21 at 1:00 PM, showed that she had not completed an EKG or cardiac rhythm identification classes since her start date of 09/23/21.

During an interview on 10/13/21 at 2:35 PM, Staff M, Nurse Manager, stated that:
- The hospital did not have a designated educator or formal orientation packet.
- She had recently created education packets that included checklists and post education tests for information she felt new employees should have.
- There was not a formal monitor technician orientation, she had created one and that the monitor technician would have 90 days to complete education and a post test for rhythm identification.

During an interview on 10/14/21 at 10:30 AM, Staff Q, Director Quality Management (DQM), stated that:
- A previous Chief Nursing Officer (CNO) had felt that monitor technicians did not need formal education for rhythm analysis, they only had to recognize that an alarm was sounding and notify the nurse.
- The monitor technician should have a working knowledge of basic rhythm recognition.
- She did not feel that it was wise to have an individual in the monitor technician position without having had some form of competency evaluation.

Based on observation, interview and policy review, the hospital failed to ensure that medications were stored appropriately.

Findings included:

1. Review of the hospital's policy titled, "Drug Storage," dated 04/2020, directed staff to ensure that all medications, biologicals, and controlled substances must be stored in a secured area, such as a locked room, a locked container, or remain under constant surveillance.

Observation on 10/13/21 at 10:00 AM, room 107, showed one tube of medicated cream lying in the open, on the edge of the counter, below a secure lock box attached to the wall.

During an interview on 10/13/21 at 10:00, Staff L, Director of Wound Care, stated that any patient specific medications, such as eye drops or tubes of cream, should be secured, stored in the lock box of the patient room, not lying on the counter top.

During an interview on 10/13/21 at 1:40 PM, Staff M, Nurse Manager, stated that patient specific creams and eye drops should be placed in the lock box in the patient room to secure them.