Select Specialty Hospital-Evansville

“RN SUPERVISION OF NURSING CARE CFR(s): 482.23(b)(3) A registered nurse must supervise and evaluate the nursing care for each patient. This Standard is not met as evidenced by: 50584 Based on document review and interview, nursing services failed to follow mobility guidelines per facility policy for 9 of 10 Medical Records reviewed. (P#2, P#3, P#4, P#5, P#6, P#7, P#8, P#9 and P#10) Findings Include: 1. Facility policy titled Mobility and Weight Bearing Guidelines, policy number M05-G, last revised 10/01/22, under Appendix 2 Mobility Levels, Mobility Level, Level 2, Expected Mobility, This is a 2 times per day intervention, Time for Cardiac Chair should be prescribed. Should be a minimum of 30 (thirty) minutes and a maximum of 2 (two) hours; under Mobility Level, Level 3, Expected Mobility, This is a two times day intervention, Time for Bed side chair/Wheel Chair should be prescribed. Should be a minimum of 30 (thirty) minutes and a maximum of 2 (two) hours. 2. Review of P2 MR indicated: a. Patient admitted to facility 5/6/24 through 8/8/24 for diagnosis of Acute and Chronic Respiratory Failure with Hypoxia. b. P2 assigned Mobility Level 2 on 5/7/24. c. On 5/9/24 from 1130 hours to 1509 hours, P2 up in chair exceeding two-hour maximum limit per facility policy. d. On 5/10/24 P2 up in chair at 1545 hours, with next documentation of returning to bed on 5/11/24 exceeding two-hour maximum limit per facility policy. e. On 5/11/24 at 1930 hours through 2231 hours, P2 up in chair exceeding two-hour maximum limit per facility policy. f. On 6/21/24 at 0450 hours through 1057 hours, P2 up in chair exceeding two-hour maximum limit per facility policy. 3. Review of P3 MR indicated: a. Patient admitted to facility 5/10/24 through 6/3/24 for diagnosis of Acute Respiratory Failure with Hypoxia. b. P3 assigned Mobility Level 3 on 5/13/24. c. On 5/13/24 from 1515 hours through 2000 hours P3 up in chair exceeding two-hour maximum time limit per facility policy. 4. Review of P4 MR indicated: a. Patient admitted to facility 5/13/24 through 6/6/24 for diagnosis of Acute Respiratory Failure with Hypoxia. b. Patient assigned Mobility level 2 on 5/14/24. c. On 5/29/24 lacked documentation of up in chair one of two times a day per facility policy. P4 up in chair from 0845 hours to 0946 hours on 5/29/24. d. On 5/30/24 lacked documentation of up in chair one of two times a day per facility policy. P4 up in chair from 0720 hours to 0830 hours on 5/30/24. e. On 5/31/24 from 0722 hours to 1610 hours, P4 up in chair exceeding two-hour time limit per facility policy. 5. Review of P5 MR indicated: a. Patient admitted to facility 5/22/24 through 6/26/24 for diagnosis of Acute and Chronic Respiratory Failure with Hypoxia. b. Patient assigned Mobility Level 3 on 5/23/24. c. On 5/28/24 and 6/1/24 lacked documentation of up in chair two times a day per facility policy. 6. Review of P6 MR indicated: a. Patient admitted to facility 5/23/24 through 6/28/24 for diagnosis of Acute Respiratory Failure with Hypoxia. b. Patient assigned Mobility level 2 on 5/24/24. c. On 5/26/24 from 1145 hours through 1453 hours, P6 up in chair exceeding two-hour maximum time limit per facility policy. d. On 5/30/24 at 0818 hours P6 up in chair with next documentation at 1044 hours of P6 out of bed exceeding two-hour maximum time limit per facility policy. 7. Review of P7 MR indicated: a. Patient admitted to facility 6/4/24 through 7/3/24 for diagnosis of Acute and Chronic Respiratory Failure unspecified with Hypoxia. b. Patient assigned Mobility Level 3 on 6/5/24. c. On 6/22/24 from 1135 hours through 1705 hours, P7 up in wheelchair exceeding two-hour time limit per facility policy. d. On 6/27/24 from 1655 hours through 0000 hours, P7 up in wheelchair exceeding two-hour maximum time limit per facility policy. 8. Review of P8 MR indicated: a. Patient admitted to facility 6/16/24 through 6/20/24 for diagnosis of Acute and Chronic Respiratory Failure with Hypoxia. b. Patient assigned Mobility Level 2 on 6/17/24. c. On 6/17/24 from 1130 hours through 1516 hours, P8 up in wheelchair exceeding two-hour maximum time limit per facility policy. 9. Review of P9 MR indicated: a. Patient admitted to facility 6/24/24 through 7/31/24 for diagnosis of Acute and Chronic Respiratory Failure with Hypoxia. b. Patient assigned Mobility Level 2 on 6/25/24. c. On 6/27/24 P9 up in chair at 2000 hours with next documentation at 6/28/24 at 0700 hours of patient up in chair exceeding two-hour maximum time limit per facility policy. d. On 6/28/24 at 0700 hours P9 up in chair with next documentation on 6/29/24 at 0815 hours of P9 refusing Physical Therapy with no indication of P9 in bed or chair. e. On 6/29/24 lacked documentation of P9 up in chair two times daily per facility policy. f. On 6/30/24 from 0915 hours through 1722 hours, P9 up in chair exceeding two-hour time limit per facility policy. g. On 7/2/24 at 0640 hours, 7/3/24 at 0822 hours and 7/4/24 at 0545 hours, P9 up in chair and lacked documentation of returning to bed each day. h. On 7/20/24 from 1300 hours through 2043 hours, P9 up in chair exceeding two-hour maximum time limit per facility policy. 10. Review of P10 MR indicated: a. Patient admitted to facility 7/5/24 through 8/1/24 for diagnosis of Acute and Chronic Respiratory Failure with Hypoxia. b. Patient assigned Mobility Level 2 on 7/8/24. c. On 7/13/24 from 1010 hours through 2045 hours, P10 up in chair exceeding two-hour maximum time limit per facility policy. d. On 7/14/24 lacked documentation of up in chair two times a day per facility policy. e. On 7/21/24 from 0825 hours through 2114 hours, P10 up in chair exceeding two-hour maximum time limit per facility policy. 11. In interview on 8/20/24 at approximately 1130 hours with A3 (Quality Coordinator/Infection Control Preventionist), he/she confirmed P2, P3, P4, P5, P6, P7, P8, P9, and P10 Medical Records lacked documentation of mobility guidelines being met for Mobility Level 2 and Level 3 patients in medical records reviewed. 12. In interview on 8/20/24 at approximately 1550 hours with N7 (Nursing Assistant), he/she indicated a Mobility Level 2 requires patient to be up in the chair two times a day for two hours maximum. If patient would like to sit up longer it is documented in the chart and patient is instructed on the risks of immobility and wound prevention measures. N7 also indicated the Nursing Assistants round every 2 two hours alternating with the Nurses every two hours equaling rounding every one hour on patients.”

“RN SUPERVISION OF NURSING CARE CFR(s): 482.23(b)(3) A registered nurse must supervise and evaluate the nursing care for each patient. This Standard is not met as evidenced by: 49128 Based on document review and interview, the facility nurses failed to follow a sedation order on 1 of 10 patients reviewed (P10). Findings include: 1. Facility policy titled, Critical Drip: Continuous Infusion of Dexmedetomidine, policy number: C47-N, last revised 07/23, indicated indicated the infusion rate will be adjusted to maintain an adequate level of sedation per the Richmond Agitation-Sedation Scale (RASS). The policy defines “0” as alert and calm, “-1” as drowsy, and “-2” as light sedation. The policy indicted assess the sedation level and adjust per LP order. 2. Facility policy titled, Critical Drip: Propofol, policy number: C39-N, last revised 10/23, indicated the infusion rate will be adjusted to maintain an adequate level of sedation per the RASS. The policy defines “0” as alert and calm, “-1” as drowsy, and “-2” as light sedation. The policy indicated assess the sedation level and adjust per LP order. 3. Facility order for Dexmedetomidine (Precedex), placed 4/4/24 at 11:05 am, indicated Sedation Goal: 0 to -1, alert, calm to drowsy. 4. Facility order for Propofol, placed 4/5/24 at 8:12 pm, indicated Sedation Goal: 0 to -1, alert, calm to drowsy. 5. Review of P10’s medical record (MR) pain/sedation flowsheet indicated, 4/8/24 through 4/12/24, the RASS scores were documented at -2, included but not limited to: 4/8/24 at 1:30 pm, 4/8/24 at 2:32 pm, 4/9/24 at 10:19 am, 4/9/24 at 11:08 am, 4/10/24 at 7:50 am, 4/10/24 at 8:26 am, 4/10/24 at 9:54 am, 4/11/24 at 11:43 am, 4/11/24 at 12:31 pm, and 4/12/24 at 10:33 am. 6. In interview, on 5/20/24 at approximately 4:00 pm, A4 (Registered Nurse, Quality Coordinator/Infection Control [RN, QCIN]) verified from 4/8/24 through 4/12/24, the RASS scores were documented at -2. A4 verified the orders for sedation did not change to reflect a sedation goal of -2.”