HospitalInspections.org

Based on findings from document reviews and interviews,the hospital has not (1), accurately differentiated the bedside care that may be provided by Licensed Practical Nurses (LPNs) from that which can only be provided by Registered Nurses (RNs) in New York State. Additionally, (2), eight/8 of 16 RNs who provide bedside care for obstetrical patients at this hospital have not received the updated electronic fetal monitoring (EFM) education planned by the hospital to be provided to all of the obstetrical RNs in 2010.

Facts and findings pertaining to (1) above include:

-- In New York State, through the Education Department's Office of the Professions (OP), the Board of Regents licenses and regulates 47 professions, including nurses (LPNs and RNs). In its publication entitled "Nursing Guide to Practice," last revised 3/08, on page 43 the OP provides the following information defining the scope of practice for LPNs and RNs:

"Nursing diagnosis by an RN is cited in section 6901 of Article 139 of the Education Law as: the identification of and discrimination between physical and psychosocial signs and symptoms essential to effective execution and management of the nursing regimen... Nursing diagnosis has been additionally interpreted by the Department as including patient assessment, that is, the collection and interpretation of patient clinical data, the development of nursing care goals and the subsequent establishment of a nursing care plan.... Thus, Licensed Practical Nurses in New York State do not have assessment privileges; they may not interpret patient clinical data or act independently on such data; they may not triage; they may not create, initiate, or alter nursing care goals or establish nursing care plans."

In summary, this information reveals that the scope of practice for LPNs does not include the performance of patient assessments or the development of nursing care plans.

-- However, per review of the hospital's current Position Description documents (not dated) for LPNs working in its Obstetrics, Medical/Surgical/Pediatrics and Critical Care units, they reference the following expectations / abilities / functions involving patient assessment and care planning activities by LPNs:

*Ability to assess neonate at delivery...

*Ability to monitor hemodynamic status of patient and correctly interpret the results.

*Demonstrates ability, under direct supervision of a RN, to perform a head-to-toe assessment on all patients and reassessments as per policy. This includes neonatal and the general patient population.

*Demonstrates ability to revise plan of care as indicated by the patient's response to treatment and evaluate overall plan for daily effectiveness.

*Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning...

*Assessing and evaluating patient and family learning needs, ability and readiness to learn.

-- During interview with the Director of Quality Management (DQM) on 12/03/10 at 10:30 a.m., she/he acknowledged the findings above.

Findings pertaining to (2) above include:

-- Per review of an internal facility document dated 7/29/09, the hospital planned to train all current OB nurses on EFM by 3/17/10, and to include the EFM training in the orientation of all newly hired OB nurses.

-- However, per review of the obstetrical staff attendance sheets for EFM training programs held at the hospital between 11-09 and 11-10, there were 3 EFM training programs held. Of the 16 obstetrical (OB) RNs currently on the hospital's staffing schedule, eight (8) of those RNs, i.e., 50% of the professional nursing staff, did not attend the update training in EFM.

-- During interview with the DQM on 12/05/10 at 10:30 a.m., the above findings were confirmed.

Based on findings from interviews, the hospital does not provide ultrasound (US) testing services on a 24 hour basis, as required by generally accepted standards of obstetrical services in the acute care setting.

Findings include:

-- Per interview with the Medical Imaging Manager on 11/18/10 at 9:00 a.m., the hospital employs two US technicians that provide services weekdays from 6 a.m. to 9:00 p.m. The US technicians are not available after 9 p.m. each day or on weekends at all. The obstetrical unit and the emergency department have portable US (sonogram) machines available 24/7 for physician use. However, only some of the hospital obstetricians, not all, can perform and interpret an US test. Further, an US test performed on one of these portable machines can not be retrospectively reviewed by a radiologist because these machines do not produce hard copy films.

-- During interview of the DQM on 12 /03/10 at 1:00 p.m., she/he stated that currently 2 of the hospital's 4 obstetricians are trained in performing and interpreting ultrasound tests.

Accordingly, when an obstetrical patient presenting to the hospital requires an US test, and one of the 2 obstetricians with US privileges is not on call, the patient must be transferred to another hospital for the test.