(b) Nursing care policies and
procedures shall be consistent with
professionally recognized standards of
nursing practice and shall be in
accordance with the Professional
Nursing Law and regulations
promulgated by the State Board of
examiners. These policies shall
include procedures for the following:
(1) noting diagnostic and
(2) assigning the nursing care
(3) infection control
(4) patient safety
(5) implementing orders for
medication and treatment, consistent
with 107.61-107.65 of this subpart.
Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to notify the patients' physician with a change in the patient's physical status for one of one medical record reviewed (MR1).
Review on January 16, 2020, of facility, "Notification of Physician Regarding Changes in Patient Status or Diagnostic Results Policy," revised February 24, 2019, revealed "A Registered Nurse will notify the patients' physician of the following changes. This list in [SIC] non-inclusive: 1. Significant changes in the patient's physical/mental/emotional status. ...3. Continuing chronic symptoms that can or may have potential for adversely affecting the patient. ..."
Review on January 16, 2020, of MR1 revealed the patient was admitted to the facility on December 18, 2019, with cellulitis of the right hand/wrist. Splint with bandage noted to be in place.
Continued review revealed on December 18, 2019, at 20:00 nursing documentation that revealed an elastic wrap bandage, splint was in place to the right arm. Further review revealed a blister had formed. No documentation that the physician was made aware of the blister was noted.
Interview on January 16, 2020, with EMP5 confirmed nursing documentation dated December 18, 2019 revealed an elastic wrap bandage, splint was in place to the right arm and a blister had formed. EMP5 confirmed there was no documentation that the physician was made aware of this blister.
Continued review on January 16, 2020, of MR1 revealed patient was taken urgently to the operating room on December 19, 2019 for surgical drainage and debridement which was felt to be due to necrotizing fasciitis (a serious bacterial infection that destroys tissue under the skin and spreads quickly).
Interview on January 16, 2020 with EMP3 confirmed MR1 was taken urgently to the operating room on December 19, 2019 for surgical drainage and debridement which was felt to be due to necrotizing fasciitis.
| ||Plan of Correction - To be completed: 02/13/2020|
On 1/16/2020, the Chief Nursing Officer and Chief Quality Officer revised the facility's Policy – Notification of Physician Regarding Changes in Patient Status or Diagnostic Results (Previous Revision 2/24/2019).
The nursing staff will be educated as to the changes in the policy with completion by 2/13/2020. The Education Department will include a review of the policy with new nurse hire orientation.
The 6 East Nurse Manager or designee will audit 10 charts per month to ensure that providers are being noted with patient condition changes as per the policy. Any outliers will be addressed by the Nurse Manager through remediation. The audit will continue until 100% compliance is noted for no less than three consecutive months.
Audit results will be reported monthly to the Quality Improvement Council, the Medical Executive Committee and the Governing Board.