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Based on interview, review of personnel files, and staff schedule, it was determined that the Governing body failed to effectively discharge its oversight responsibilities based on the findings during the survey on 03/20/13, and 03/21/13. The failed practice affected the 16 patients with telemetry orders on the Unit at the time of the survey and had the potential to affect all patients admitted to the facility with orders for telemetry. See A 385, A 397

Based on observations, interview, review of personnel files, clinical records and staff schedule, it was determined the facility failed to have a process in place to assure three (#2, #3 and #4) of four (#1 through #4) Monitor Technician staff assigned to monitor the physician ordered telemetry were trained in arrhythmia interpretation. Without evidence of training and an assessment of the competency of the staff, it could not be assured the Monitor Technicians would recognize, interpret and report cardiac arrhythmia upon occurrence, which placed the 16 patients with orders for telemetry at risk of Immediate Jeopardy to their health and safety. The findings were:

A. Clinical record review on 03/21/13 revealed 16 of 30 patients had physician orders for telemetry.

B. The personnel files for five of five (#1 through #5) Monitor Technicians were requested from the facility. Monitor Technician #1 had copies of certificates of completion for arrhythmia interpretation courses for 1999 and again in 2002. Monitor Technician #2, #3 and #4 did not have evidence of completion of a Monitor Technician Course, Basic Arrhythmia interpretation Course or competency assessment for arrhythmia interpretation. Monitor Technician #5 was recently hired and still in orientation and was not assigned independently.

C. At 1630 on 03/20/13, the Director of Nursing confirmed the facility did not have documented evidence of training or an assessment of competency for Monitor Technicians #2, #3 or #4.

D. The schedule for the facility was reviewed on 03/20/13 from 03/1/13 - 03/20/13 and revealed there were 26 of 40, 12 hours shifts assigned to Monitor Technicians #2, #3 or #4 that the facility personnel records lacked evidence of training or competency in cardiac arrhythmia interpretation. Review of the census and staffing records from 03/01/13-03/20/13 revealed one or more patients on each shift who had physician orders for telemetry. The findings were confirmed on 03/21/13 at 1045 by RN #1.

E. Review of the facility job description for "Monitor Technician" provided by the Director of Nursing on 03/21/13 at 1100 revealed the following statements:
"The Monitor Technician is responsible for recognition and interpretation of cardiac rhythms in a facility with a patient population of ages ranging form 18 years to geriatric. The Technician monitors heart rhythm patterns of patients on telemetry or cardiac monitoring equipment and reports outcomes."

"Successful completion of a Monitor Technician Course or Basic Arrhythmia Interpretation Competency is required. Previous experience as a Certified Nursing Assistant, EMT or paramedic preferred."

Based on observations, interview, review of personnel files, clinical records and staff schedule, it was determined the facility failed to have a process in place to assure three (#2, #3 and #4) of four (#1 through #4) Monitor Technician staff assigned to monitor the physician ordered telemetry were trained in arrhythmia interpretation. Without evidence of training and an assessment of the competency of the staff, it could not be assured the Monitor Technicians would recognize, interpret and report cardiac arrhythmia upon occurrence, which placed the 16 patients with orders for telemetry at risk of Immediate Jeopardy to their health and safety. See A 0385