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Based on medical record review, staff interview, and review of policy and procedures it was determined the Registered Nurse failed to supervise and evaluate the nursing care for 1 (#1) of 4 patients sampled. This practice does not ensure patient goals are met and may prolong the hospital stay.

Findings include:

1. Patient #1 was admitted on 2/15/11 with tube feedings and being ventilator dependent. Review of nursing documentation for the nursing intervention of checking the patient's residual stomach contents, while the patient was receiving the tube feedings, revealed the checks were not done consistently. On 3/07/11 from 8:00 a.m. to 4:00 p.m. there was no documentation the residual was checked by nursing. On 3/09/11 from 1:30 p.m. until 8:00 p.m. there was no documentation the residual was checked.

Review of the facility's nursing procedure for patients receiving tube feedings indicated to check residual volume every 4 hours and document results.

Review of physician orders dated 4/16/11 revealed an order to check residuals every 4 hours. Review of the nursing documentation on 4/16/11 revealed no documented residual for 4:00 p.m., 8:00 p.m., or 12:00 a.m.

An interview with the RN (Registered Nurse) team leader on 6/09/11 at 3:05 p.m. confirmed there was no documentation of the residual on the above dates and times.


2. Patient #1's physician order dated 3/25/11 revealed an order for TPN (Total Parental Nutrition). Review of the physician order revealed that the patient was to be weighed daily while on TPN. Review of the nursing documentation revealed the patient was weighed on 3/25/11. Review of the record revealed the patient received TPN from 3/25/11 to 4/01/11. Review of the nursing documentation revealed the patient was not weighed during that time.

Tube feedings were re-started without success.. On 4/27/11 the patient was placed on TPN and an order for daily weights was initiated. The patient remained on TPN until 5/05/11. Review of nursing documentation revealed the patient was not weighed from 4/28/11 through 5/01/11 and 5/04/11.

An interview with the RN team leader on 6/09/11 at 3:05 p.m. confirmed there was no documentation of the daily weight during the times stated.

3. Patient #1's nursing assessments revealed on 3/3/11 a nursing assessment was not completed during the 7:00 a.m. to 7:00 p.m. shift. Documentation revealed an RN assessed the patient on 3/2/11 at 7:00 p.m. and then again on 3/3/11 at 7:00 p.m.

An interview with the RN team leader and Director of Quality on 6/9/11 at 3:05 p.m. confirmed there was no documentation that an RN assessed the patient.

Review of the facility's policy, "Assessment/Reassessment", last revised 2/2011, stated patients will be reassessed at least every shift.

4. Patient #1's admission orders on 2/15/11 revealed a physician order for vital signs every 4 hours. Review of the nursing documentation revealed vital signs were not done every 4 hours. Review of the graphic form recording of vital signs revealed the patient's vital signs were completed every 8 to 12 hours.

An interview with the RN team leader and Director of Quality on 6/9/11 at 3:05 p.m. confirmed nursing did not follow the physician's orders for vital signs every 4 hours.