HospitalInspections.org

.
Based on observation, interview, and document review, the hospital failed to ensure the Hospital operated under one unified nursing service under the direction of one Registered Nurse who was responsible for the quality of care provided to hospital patients by hospital and non-hospital nursing staff.

Failure to ensure that Nursing Services are provided under the direction of one hospital-wide nursing service under the direction of one Registered Nurse accountable for the quality of nursing care provided to its patient's places patients at risk for inconsistent or inadequate care, adverse outcomes, and death.

Findings included:

1. The hospital failed to ensure that St. Michael Medical Center operated with one hospital-wide Nursing Service, and failed to ensure that a single nursing service was under the direction of one Registered Nurse (RN) responsible for the operation of the services and the quality of the patient care provided by nursing services.

Cross Reference: A0386
.

.
Based on interview and document review, the hospital failed to ensure that St Michael Medical Center hospital operated with one hospital-wide Nursing Service, and failed to ensure that a single nursing service was under the direction of one Registered Nurse (RN) responsible for the operation of the service and the quality of the patient care provided by nursing services.

Failure to ensure that Nursing Services are provided under the direction of one hospital-wide nursing service under the direction of one Registered Nurse places patients at risk for suboptimal care, adverse outcomes, and death.

Findings included:

1. Document review of the hospital's organizational chart titled, "St. Michael Medical Center," dated 02/24, showed the following:

a. The Family Birth Center, Acute Care Services (Intensive Care Unit, Cardiovascular Progressive Care Unit, Progressive Care Unit Cardiopulmonary, the Hospital Registered Nurse Supervisors (RN) and Critical Care Educators), Emergency Services, Oncology Services, and Care Coordination reported directly to the Chief Nursing Officer.

b. Perioperative Services including the Orthopedic Operating rooms, Orthopedic preadmission, and post anesthesia care unit, Cardiac Cath Lab and EP Lab, and the Main Operating Room also including Preoperative, Preadmissions, and Post Anesthesia Care Units reported directly to the St. Michaels Medical Center President.

c. A notation on the document stated, "CNO has matrixed oversight for all nursing practice at St. Michael Medical Center."

d. The Organization chart stated that positions with a solid double line box indicated Direct Report director level and above. The position of Perioperative Services Director showed a double line box that linked directly to the Hospital President.

Document review of the Job Description for the job title, "Director Perioperative Service," states that the position reports to, "Depends on facility assigned." Under the section titled, "Job Summary," the document stated, "working with the Medical Director and other hospital department managers to integrate/coordinate/evaluate all phases of patient care," and "providing input to the hospital President of development, implementation, monitoring, and other operational issues."

Investigator #5 was unable to determine any reporting structure to the CNO for Perioperative Services or the Perioperative Services Director.

Document review of the Director of Perioperative Service's (Staff #514) job evaluation titled, "Annual Performance Review FY23-Leader. Review Period 07/01/22-06/30/23 showed that the review was completed and signed by this staff person's manager identified in the document as the President of St Michael Medical Center (Staff #513).
Investigator #5 found no evidence the CNO was responsible for the operation of the service "Perioperative Services or evaluated the performance of Staff #514 as part of his/her responsibility for a single nursing service under the direction of one Registered Nurse.

2. On 03/07/23 at 3:28 PM, Investigator #5 and the President of St Michael Medical Center (Staff #513) discussed the hospital's organizational chart and nursing services. Staff #513 verified that all Perioperative Services reported to him and that he was not a nurse. He stated that the organization's philosophy was to work in a Dyad and that he and the CNO (Staff #516) give continuous feedback about services and practice. He stated that this is also completed during Performance Calibration Meetings.

Staff #513 provided Investigator #5 with meeting minutes titled, "SMMC Performance Calibration Meeting, 06/19/23 4 PM-5PM." The document showed a list of names titled "guests" with check marks next to their names that included Staff #513, #514, and #515. The CNO (Staff #516) and the Chief Medical Officer (Staff #517) were on the printed list, but the names were not checked.

Staff #513 verified that the names were not checked but stated that the CNO was in attendance.

Review of the meeting minutes showed that the document listed out and defined the purpose and process of the meeting. Investigator #5 found no evidence the CNO (Staff #516) provided input, or oversight for the Director of Perioperative Services (Staff #514) or any other documentation that would demonstrate that the hospital had only one nursing service hospital-wide and the single nursing service was under the direction of one RN (Staff #516). The document did not reflect any specific information for either Director level staff in attendance, Staff #514 or #515.
.