HospitalInspections.org

Based on review of facility documents, interviews with staff (EMP), and observations, it was determined that the facility failed to maintain a nursing staff to provide nursing care for the needs of cardiac monitored patients.

Findings include:

Review of "Cardiac Monitoring ... Revision Date(s) ... June 2010" revealed "Policy All patients requiring cardiac monitoring will be connected to the monitoring station (hardwired) or will have a telemetry monitor attached and monitored at at remote station. Cardiac Monitoring will be under the surveillance of either a monitor tech/unit secretary or a nurse specially trained in telemetry. Procedure ... H. Monitors should never be left without a qualified clinician monitoring them. 1. If no qualified person is available to take the place/cover for the monitor tech, the monitor tech may not leave their station. 2. Monitor techs need to be relieved for lunch and breaks by qualified replacements such as nurses who have passed an EKG Exam. The Nursing Supervisor should assign times every shift to a qualified replacement. 3. The monitor tech will focus their attention on the monitor screens. ... If a break is needed, the monitor tech should ask a qualified nurse or supervisor for coverage."

1) Review of "LifeCare Hospitals of Pittsburgh Suburban Campus Assignment Sheets" from June 1, 2011, to June 30, 2011, revealed 15 dates where there was no documented evidence that a "US/MT [Unit Secretary/Monitor Tech]" was assigned to the "7P-7A [7 PM to 7 AM]" shift. Further review of these forms revealed no other staff members assigned to observe monitored patients. Additional review revealed that on June 22 and June 24, 2011, a nurse was assigned to be the "Charge Nurse" and the "US/MT."

2) Review of "Daily Midnight Census Inpatient" reports from June 1, 2011, to June 30, 2011, revealed that on the 15 dates listed above, there were a total of between 10 to 19 patients who were on cardiac monitoring.

3) During a tour of the facility on July 15, 2011, at approximately 10:15 AM, observations revealed that there is one cardiac monitoring screen for the "High Intensive Unit" nursing station and multiple cardiac monitoring screens for the "Intermediate Unit" nursing station.

4) During a tour with EMP1 on July 15, 2011, at approximately 10:20 AM, EMP1 confirmed that there is a monitor tech assigned to the "Intermediate Unit" but there is not a monitor tech assigned to the "High Intensive Unit." Further interview revealed that the monitors on each of these units only alarm at their respective nursing stations and do not alarm at both stations.

5) Interview with EMP2 on July 15, 2011, at approximately 12:40 PM confirmed the above findings and revealed "It's what is in our policy but not in practice ... We are in the process of updating this policy ... It is the RN's responsibility to watch the monitors."