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Based on interview and record review, the hospital failed to ensure the RN supervised/evaluated patient care needs for 1 of 1 patient (Patient #1) who required the IV (Intravenous) site changed every 72 hours per hospital policy.

Findings Included :

The nursing note dated 8/1/09 timed at 5:00 am reflected an IV heparin lock was placed in the right hand. The IV heparin lock was changed to the left forearm on 8/10/09. It should be noted, the IV site was only changed one time during Patient #1's hospital stay from 7/31/09 to 8/12/09. The IV should have been resited on 8/4/09 and 8/7/09.

The MAR (medication administration record) dated 7/31/09 to 8/12/09 reflected no documentation indicating resiting of the IV.

On 01/06/10 at 10:40 am LVN #2 was interviewed. LVN #2 was asked by the surveyor how often the IV sites are changed. LVN #2 stated every three days.

On 01/05/10 at approximately 1:15 PM the CNO was interviewed. The surveyor asked the CNO to review Patient #1's nursing notes for documentation indicating Patient #1's IV site was changed every 72 hours. The CNO confirmed the nursing notes did not indicate the IV was resited every 72 hours.

The policy entitled, "Peripheral IV Therapy Management" dated 09/07 reflected under "Heparin Locks, B. Site Care (IV and/or Heparin lock) 2. Change site every 72 hours and PRN (as needed) using aseptic technique..."

Based on review of documents, interviews and observation, the hospital failed to follow their policy for providing orientation and performance evaluation for 3 of 3 ( NE #1,2,3) nonemployee licensed nurses who provided direct patient care and/or supervised nursing staff between 8/12/09 and 1/07/10.

Findings Included :

NE #1 noted the performance of shift assessment for patient # 7 on 8/12/09.
NE #1 noted the performance of shift assessment for patient # 8 on 8/13/09.
NE #1 noted the performance of shift assessment for patient # 10 on 8/13/09.

NE #2 noted the performance of shift assessment for patient # 9 on 8/13/09.

Daily staffing sheets showed NE #3 was charge nurse for day shifts on 01/05/10 and 01/06/10 . The assignment sheets for these dates showed the census for each day was 15, and direct caregivers included licensed and unlicensed nursing staff.

In an interview with NE #3 on afternoon of 1/7/10, she was asked whether or not she was employed by the hospital and what her duties were. She replied that she was employed by a staffing agency and was charge nurse today and has been charge nurse on other dates. She was asked whether her perfomance had been evaluated and she stated no.

In an interview with the CNO on the afternoon of 1/6/10, she was asked how nonemployee nurses were oriented or evaluated. She stated she had no system in place for either orientation or evaluation.

During a tour of the medical floor on the morning of 1/6/10, the surveyor observed NE#3 as she made rounds and supervised nursing staff giving direct care.

Hospital policy "Hospital Orientation" revised 05/05 requires that contract employees recieve orientation and verification of competency.

Based on interview and record review an IV (intravenous) medication was not administered by licensed nursing personnel in accordance with state law for 1 of 1 Patient's (Patient #1).

Findings Included :

1) Patient #1's MAR (medication administration record) reflected , "Remodulin injectable 25.5 mg (milligrams) sq (subcutaneous) every 24 hours." Entries on the MAR's dated 7/31/09, 8/3/09, 8/6/09, 8/10/09 and 8/12/09 reflected, "provided by family...wife...daughter."

The nursing admission assessment dated 7/31/09 timed at 1925 reflected, "patient has port for home medication Remodulin patent and med changes by wife and set-up by wife as she has been doing this awhile at home..."

On 1/6/10 at 10:00 am, LVN (licensed vocational nurse) #1 was interviewed. The surveyor asked if the hospital allowed family to administer medications during the patient stay. LVN #1 stated no, they do not.

On 1/6/10 at 11:00 am, the Director of Pharmacy was interviewed. The surveyor asked if the hospital allowed family to administer medications during the patient stay. He said no, we do not. The pharmacist was asked by the surveyor to review Patient #1's MAR. The pharmacist reviewed the MAR and stated he was not aware that the patient's family members were administering medications.

On 1/6/10 at 11:30 am, the CNO (chief nursing officer) was interviewed. The surveyor asked if the hospital allowed family to administer medications during the patient stay. The CNO stated she was unaware of any patients families administering medications in the facility. The CNO said nursing staff should be administering medications.

The Texas Administrative Code, Standards of Nursing Practice, Title 22, Part 11, Chapter 217, Rule 217.11 reflected, "(1) Standards Applicable to All Nurses. All vocational nurses, registered nurses and registered nurses with advanced practice authorization shall:
(D) Accurately and completely report and document:
(iv) administration of medications and treatments."

Based on review of documents and interviews, the hospital failed to identify the lack of orientation and performance evaluations for 3 of 3 ( NE#1,2 and 3) nonemployee licensed personnel who provided and/or supervised direct patient care from 8/12/09 to 1/7/10.

Cross refer to tag 0398.

Findings Included:

In an interview with NE (nonemployee) #3 on 1/7/10 at approximately 4:00 pm, she was asked whether or not she was employed by the hospital and what her duties were. She replied that she was employed by a staffing agency and that she is a charge nurse. She was asked whether her perfomance had been evaluated and she stated no.

In an interview with the CNO on 1/6/10 at approximately 3:15 pm, she was asked how nonemployee nurses were oriented or evaluated. The CNO stated she had no system in place for either orientation or evaluation of nonemployees at the current time.

The hospital policy entitled, "Hospital Orientation" dated 05/05 requires that contract employees recieve orientation and verification of competency.