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TEXOMA MEDICAL CENTER 5016 S US HIGHWAY 75 DENISON, TX 75020 April 25, 2017
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
Based on interview and record review, the hospital's registered nurse (RN) failed to supervise and evaluate the nursing care, in that 2 of 10 patients (Patient #1 and #2) had high systolic blood pressures and were not reassessed and/or pain medication was administered and no reassessment was conducted during their stay in the emergency department (ED) from 11/9/16 through 04/24/17.

Findings included:

Patient #1 presented in the ED on 11/09/16 8:02 AM for right knee pain and back pain. Patient #1's initial vital signs taken at 8:06 AM included a "systolic blood pressure (SBP) H (high) 173. Patient #1's SBP of 173 mmHg was considered high. There was no nursing reassessment of the SBP during Patient #1's visit in the ED. There was no blood pressure obtained after the initial vital signs were taken at 8:06 AM. Patient #1 was discharged to home at 9:57 AM on the same day.

Patient #2 presented in the ED on 04/24/17 at 4:49 PM for left ankle pain with pain of 7 on a pain scale of 10. Patient #2's initial vital signs taken at 4:54 PM included a "SBP H (high) 160" and DBP 76." There was no nursing reassessment of the SBP during Patient #2's visit in the ED. There was no blood pressure obtained after the initial vital signs were taken at 4:54 PM.

Patient #2 was given an oral dose of Tylenol #3 at 6:39 PM per physician's order. There was no nursing reassessment if Patient #2 had pain relief or needed more intervention. Patient #2 was discharged to home at 7:35 PM on the same day.

In an interview on 04/25/17 at 1:50 PM, Personnel #4 was informed of the above findings and confirmed the findings. Personnel #4 was asked to provide the hospital's BP parameters. She informed the surveyor that the normal SBP was 90-140 mmHG. Personnel #4 stated the parameters were included in hospital's computer database for the vital signs. If the BP was not within the normal parameters the BP number would be indicated in "red" and an "H" to mean it was high.

NS 1.2 "Patient Assessment, Admission and On-going Reassessment" reviewed 09/2016 required "3...RNs will conduct a comprehensive admission assessment on all patients within time frames appropriate to their level of care as outlined in policy/guideline."

PC 234 "Pain Management" revised 04/2016 page 2 required "5...A. Reassessing pain intervention for effectiveness should be in a time frame appropriate to the treatment provided. For example, oral medications will be reassessed within 1-2 hours."
VIOLATION: PATIENT RIGHTS: GRIEVANCE REVIEW TIME FRAMES Tag No: A0122
Based on interview and record review, the hospital failed to enforce the patient right's policy, in that 1 of 10 patients (Patient #1) did not receive a prompt/ timely acknowledgment letter informing him that the hospital needed time to resolve his grievance.

Findings included:

The hospital administration received Patient #1's complaint on 11/17/16. The first letter of response acknowledging the receipt of the complaint and informing Patient #1 that the hospital needed time to resolve his grievance was sent on 12/05/16, 18 days after receiving Patient #1's complaint.

In an interview on 04/25/17 at 12:15 AM, Personnel #3 was informed of the above findings and confirmed the findings. Personnel #3 stated Patient #1's complaint letter remained in the administration office for a while.

Hospital policy GE 256 "Patient Grievance/Complaint Management" reviewed 12/2015 page 3 required "C ...vi. If the grievance will not be resolved, or the investigation is not or will not be completed within 7-10 days, the hospital should send an acknowledgment letter informing the patient ...the hospital is still working to resolve the grievance ..."