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Based on interview and record review, the hospital failed to ensure the nurse-to-patient ratio was maintained at all times in the L&D unit as required. This failure had the potential for patient care needs not being met when the staffing ratio was not maintained as required.

Findings:

Review of the hospital's P&P titled Staffing Perinatal Services, Labor and Delivery, Couplet Care and Ante-Partum dated 6/22/22, showed the following:

* Minimum staffing in Labor and Delivery when 0 patient is 2 licensed staff and 1 RN on call.

* Nurse/Patient Ratio:
1:2 Patients in labor
1:1 Patients in active pushing phase of second-stage labor...
1:1 Continuous bedside nursing attendance during initiation of epidural anesthesia until condition is stable (or at least the first 30 minutes after the initial dose) ...
2:1 At birth: 1 nurse responsible for the mother and 1 nurse responsible for the baby until stable...

On 7/23/25 at 0830 hours, Clinical Shift Manager 1 was interviewed. Clinical Shift Manager 1 stated the nurse-to-patient ratio should be 1:1 for at least 30 minutes after the epidural anesthesia initiation and one hour after the baby was delivered.

On 7/23/25, Patient 1's closed medical record was reviewed. The record showed Patient 1 was admitted to the hospital on 6/27/25 and discharged on 6/29/25. Review of the Patient Progress Notes dated 6/28/25, showed the following:

* At 0120 hours, the epidural catheter was inserted, and test dose was given.
* At 0230 hours, Patient 1 was pushing and the physician enroute.
* At 0252 hours, normal spontaneous vaginal delivery.

Review of the L&D Assignment Sheet dated 6/27/25 for the night shift (from 1800 to 0600 hours), showed the following:

* From 0120 hours to 0150 hours (for 30 minutes), RN 1 was assigned to Patient 1 who was in active labor and to one L&D patient.
* From 0230 hours to 0352 hours (for one hour and 22 minutes), RN 1 was assigned to Patient 1 who had just given birth and to one L&D patient.

On 7/23/25 at 1010 hours, Clinical Shift Manager 1 verified the above findings. The nurse-to-patient ratio was not maintained at all times in the L&D unit as required.

Based on interview and record review, the hospital failed to ensure the nursing staff developed the nursing care plan for one of two sampled patients (Patient 2) when the blood transfusion was administered, creating the risk of not providing necessary care and services to meet the care needs for the patient.

Findings:

Review of the hospital's P&P titled Interdisciplinary Plan of Care dated 2/28/24, showed the following:

* Patient problems identified in the plan of care are reviewed by all disciplines caring for the patient.

* The plan of care is updated every 72 hours or when there is a change in the patient's condition. Updates are done by any discipline providing care to the patient.

* The plan of care consists of patient problems, expected outcomes, goals, and interventions/approaches.

On 7/23/25, Patient 2's medical record was reviewed. Patient 2's medical record showed Patient 2 was admitted to the hospital on 7/17/25.

Review of the physician's order dated 7/21/25 at 1912 hours, showed to administer blood product.

Review of the Transfusion Information dated 7/21 and 7/22/25, showed three units of blood were administered to Patient 2.

The Interdisciplinary Plan of Care for Patient 2 was reviewed. The record failed to show the nursing care plan for blood transfusion.

On 7/23/25 at 1300 hours, the CNO and the Director of Quality Department verified the above findings.