Select Specialty Hospital Columbus

“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: 21893 Based on medical record review, staff interview, and policy review, the facility failed to ensure bedfast patients were turned and repositioned every two hours. This affected three (Patients #1, #3, and #6) of ten patients reviewed. The facility census was 22. Findings include: 1. Review of the medical record for Patient #1 revealed a diagnosis of quadriplegia and orders to turn and reposition the patient every two hours. The medical record contained documentation of repositioning every two hours with all positions listed as semi-fowlers on 02/19/25 from 12:00 AM through 8:00 AM, on 02/19/25 from 8:00 PM through 8:00 AM on 02/20/25, on 02/20/25 from 8:00 PM through 8:00 AM on 02/21/25, on 02/21/25 from 8:00 PM through 10:00 AM on 02/22/25, on 02/22/25 from 8:00 PM through 7:30 AM on 02/23/25, on 02/24/24 from 7:00 PM through 3:00 AM on 02/25/25, and on 03/03/24 from 2:00 PM through 7:46 AM on 03/04/25. The medical record contained documentation of repositioning every two hours with all positions listed as right side on 03/02/25 from 4:00 PM through 8:00 PM. No repositioning was documented on 02/20/25 from 12:14 PM through 5:19 PM, on 02/22/25 from 2:00 PM from 7:00 PM, on 02/25/25 from 3:00 AM through 5:57 AM, and on 02/28/25 from 6:00 AM through 10:00 AM. During an interview on 05/21/25 at 3:30 PM, Staff A and B verified the above information. 2. Review of the medical record for Patient #3 revealed immobility and orders for turning and repositioning every two hours. The medical record contained documentation of repositioning every two hours listed as right side from 5:38 AM through 10:00 AM. During an interview on 05/22/25 at 1:15 PM, Staff A and B verified the above information. 3. Review of the medical record for Patient #6 revealed immobility and orders for turning and repositioning every two hours. The medical record contained lacked documentation of repositioning on 04/19/25 from 2:00 AM through 6:00 AM and from 1:00 PM through 8:00 PM. The medical record contained documentation of repositioning every two hours with all positions listed as semi-fowlers on 04/19/25 from 8:00 PM through 7:00 AM on 04/20/25. During an interview on 05/22/25 at 1:50 PM, Staff A and B verified the above information. Review of “Guidelines and Protocols, Clinical Policy”, revised 01/01/25, stated bedfast patients are to be turned every two hours.”

“CONTENT OF RECORD: ORDERS,NOTES,REPORTS CFR(s): 482.24(c)(4)(vi) [All records must document the following, as appropriate:] All practitioner’s orders, nursing notes, reports of treatment, medication records, radiology and laboratory reports, and vital signs and other information necessary to monitor the patient’s condition. This Standard is not met as evidenced by: 21893 Based on medical record review and staff interview, the facility failed to ensure all medication and vital signs documentation were completed. This affected six (Patients #1, #2, #3, #5, #6, and #10) of ten patients reviewed. The facility census was 22. Findings include: 1. Review of the medical record for Patient #1 revealed orders for continuous telemetry. Patient #1 had orders for Apresoline every eight hours with instructions to hold if systolic blood pressure is less than 110. Patient # 1 had orders for Isordil three times a day with orders to hold if systolic blood pressure is less than 90. Patient #1 had orders for Midodrine three times a day with orders to hold if systolic blood pressure is over 120. Patient #1 had orders for Lasix twice a day with instructions to hold if systolic blood pressure is under 95. Patient #1 had orders for Lopressor twice a day with orders to hold if heart rate is less than 65 or systolic blood pressure is less than 100. There were instances in which the medication was held due to not meeting parameters. Blood pressures and heart rates were not documented on the Medication Administration Record and blood pressures were not always documented on the Vital Signs Sheet for the times the medication was given. During an interview on 05/21/25 at 3:30 PM, Staff A and B verified the above information. 2. Review of the medical record for Patient #2 revealed orders for continuous telemetry. Patient #2 had orders for Midodrine three times a day with instructions to hold if systolic blood pressure is over 100. There were 25 instances in which the medication was held due to not meeting parameters. Blood pressures were not documented on the Medication Administration Record and blood pressures were not always documented on the Vital Signs Sheet for the times the medication was given. During an interview on 05/22/25 at 1:10 PM, Staff A and B verified the above information. 3. Review of the medical record for Patient #3 revealed orders for continuous telemetry. Patient #3 had orders for Midodrine three times a day with instructions to hold for systolic blood pressure greater than 120. There were instances in which the medication was held due to not meeting parameters. Blood pressures were not documented on the Medication Administration Record and blood pressures were not always documented on the Vital Signs Sheet for the times the medication was given. During an interview on 05/22/25 at 1:15 PM, Staff A and B verified the above information. 4. Review of the medical record for Patient #5 revealed orders for continuous telemetry. Patient #5 had orders for Lopressor twice a day with orders to hold if heart rate is less than 60 or systolic blood pressure is less than 110. There were instances in which the medication was held due to not meeting parameters. Blood pressures and heart rate were not documented on the Medication Administration Record and blood pressures were not always documented on the Vital Signs Sheet for the times the medication was given. During an interview on 05/22/25 at 1:40 PM, Staff A and B verified the above information 5. Review of the medical record for Patient #6 revealed orders for continuous telemetry. Patient #6 had orders for Norvasc daily with instructions to hold if systolic blood pressure is less than 100. Blood pressures were not documented on the Medication Administration Record and blood pressures were not always documented on the Vital Signs Sheet for the times the medication was given. During an interview on 05/22/25 at 1:50 PM, Staff A and B verified the above information. 6. Review of the medical record for Patient #10 revealed orders for continuous telemetry. Patient #10 had orders for Coreg twice a day with instructions to hold if heart rate is less than 50 or systolic blood pressure is less than 100. Patient #10 had orders for Apresoline every eight hours with instructions to hold if systolic blood pressure is less than 100. Patient #10 had orders for Entresto twice a day with instructions to hold if systolic blood pressure is less than 100. There were instances in which the medication was held due to not meeting parameters. Blood pressures or heart rate were not documented on the Medication Administration Record and blood pressures were not always documented on the Vital Signs Sheet for the times the medication was given. During an interview on 05/22/25 at 3:00 PM, Staff A and B verified the above information. During an interview on 05/21/25 at 3:30 PM, Staff A and B stated the nurses would verify the vital signs on the telemetry monitor prior to administering medications. The telemetry readings do not transfer into the electronic medical record. The Medication Administration Record (MAR) does not require the nurse to enter the vital signs in the MAR. They verified that there were not vital signs documented in the electronic medical record for all of the medication administration times because of this. They did state that there were medications that were held due to not meeting parameters.”

“PATIENT RIGHTS: RESTRAINT OR SECLUSION CFR(s): 482.13(e)(5) §§482.13(e)(5) - The use of restraint or seclusion must be in accordance with the order of a physician or other licensed practitioner who is responsible for the care of the patient and authorized to order restraint or seclusion by hospital policy in accordance with State law. This Standard is not met as evidenced by: 21893 Based on medical record review and staff interview, the facility failed to ensure restraint use was in accordance with the physician’s order. This affected three of five patients reviewed for restraints (Patients #5, #7, and #10). The facility’s census was 22. Findings include: 1. Review of the medical record for Patient #5 revealed orders for secured mittens from 11/22/24 at 11:51 AM through 12/10/24 at 11:59 AM. The medical record contained documentation on 12/06/24 at 8:00 PM of unsecured mittens, on 12/07/24 at 9:11 AM of bilateral soft wrist restraints, on 12/07/24 at 9:24 AM of one secured and one unsecured mittens, and on 12/10/24 at 8:00 AM of unsecured mittens. The medical record contained orders for unsecured mittens from 12/10/24 at 11:59 PM through 12/31/24 at 11:00 AM. The medical record contained documentation on 12/18/24 at 8:00 AM of bilateral soft wrist restraints, on 12/18/24 at 8:00 PM of one secured and one unsecured mittens, on 12/23 at 8:00 PM of one secured and one unsecured mittens, and on 12/30/24 at 7:29 AM of secured mittens. The medical record lacked documentation of any restraint order changes for the above dates and times when the ordered restraint was not used. Interview on 01/02/25 at 1:45 PM, Staff A verified the findings. 2. Review of the medical record for Patient #7 revealed orders for unsecured mittens from 10/22/24 at 8:56 AM through 11/01/24 at 6:08 PM. The medical record contained documentation on 10/29/24 at 9:02 AM and on 10/30/24 at 7:41 AM of bilateral soft wrist restraints. The medical record contained orders for secured mittens from 11/01/24 at 6:08 PM through 11/09/24 at 7:00 PM. The medical record contained documentation on 11/02/24 at 8:00 AM of bilateral soft wrist restraints and on 11/05/24 at 11:35 AM of unsecured mittens. The medical record contained documentation of bilateral soft wrist restraints in place from 11/12/24 at 9:58 PM through 11/15/24 at 6:00 AM. The medical record lacked an order for restraints on 11/13/24. The medical record contained an order for bilateral wrist restraints on 11/16/24 at 9:24 PM and 11/18/24 at 3:43 AM. The medical record lacked an order for restraints on 11/17/24. The medical record contained documentation of bilateral soft wrist restraints in place on 11/17/24. The medical record lacked documentation of any restraint order changes for the above dates and times. Interview on 01/02/25 at 3:20 PM, Staff A verified the findings. 3. Review of the medical record for Patient #10 revealed orders for bilateral soft wrist restraints from 12/10/24 at 2:57 PM through 12/16/24 at 9:15 PM. The medical record contained documentation on 12/16/24 at 8:00 PM of secured mittens. The medical record contained orders for unsecured mittens from 12/16/24 at 9:15 PM through 12/25/24 at 5:31 PM. The medical record contained documentation of secured mittens from 12/16/24 at 9:15 PM through 12/25/24 at 5:31 PM. The medical record contained orders for secured mittens from 12/25/24 at 5:31 PM through 01/02/24. The medical record contained documentation of unsecured mittens on 12/29/24 at 8:00 PM through 12/30/24 at 8:00 PM. The medical record lacked documentation of any restraint order changes for the above dates and times. Interview on 01/02/25 at 4:30 PM, Staff A verified the findings.”

“PATIENT RIGHTS: RESTRAINT OR SECLUSION CFR(s): 482.13(e)(10) The condition of the patient who is restrained or secluded must be monitored by a physician, other licensed practitioner or trained staff that have completed the training criteria specified in paragraph (f) of this section at an interval determined by hospital policy. This Standard is not met as evidenced by: 21893 Based on medical record review, policy review, and staff interview; the facility failed to ensure the condition of the patient who is restrained was monitored by a physician, other licensed practitioner or trained staff at an interval determined by hospital policy for three of five patients reviewed for restraints (Patients #5, #7, and #10). The facility’s census was 22. Findings include: Review of the policy titled “Restraints and Seclusion,” revised 01/01/24, revealed documentation every two hours of observations of safety, comfort, mobility, skin integrity, food/hydration, and toileting. 1. Review of the medical record for Patient #5 revealed orders for restraints from 11/22/24 through 12/31/24. The medical record lacked documentation every two hours of safety checks on 12/06/24 from 4:00 AM to 8:00 AM, on 12/07/24 from 5:33 AM to 9:11 AM, on 12/14/24 from 4:00 PM to 8:00 PM, on 12/23 from 4:00 AM to 10:00 AM, on 12/25/24 from 4:00 AM to 8:00 AM, and on 12/26/24 from 6:00 AM to 2:00 PM. Interview on 01/02/25 at 1:45 PM, Staff A verified the findings. 2. Review of the medical record for Patient #7 revealed orders for restraints from 10/22/24 through 11/18/24. The medical record lacked documentation every two hours of safety checks on 10/10/24 from 6:00 AM to 9:36 AM, on 10/10/24 from 9:36 AM to 12:00 PM, on 10/20/24 from 6:00 AM to 10:00 AM, on 10/26/24 from 4:00 AM to 7:33 AM, on 10/28/24 from 6:00 AM to 12:00 PM, on 11/02/24 from 6:00 AM to 10:00 AM, on 11/08/24 from 6:00 AM to 10:00 AM, and on 11/17/24 from 10:00 AM to 8:00 PM. Interview on 01/02/25 at 3:20 PM, Staff A verified the findings. 3. Review of the medical record for Patient #10 revealed orders for restraints from 12/10/24 through 01/02/25. The medical record lacked documentation every two hours of safety checks on 12/15/24 from 4:00 PM to 8:00 PM, on 12/22/24 from 2:00 PM to 8:00 PM, on 12/23/24 from 6:00 AM to 9:01 AM, on 12/23/24 from 9:01 AM to 12:00 PM, on 12/24/24 from 6:00 AM to 10:00 AM, on 12/25/24 from 4:00 PM to 8:00 PM, on 12/26/24 from 5:58 AM to 10:00 AM, on 12/31 from 2:00 AM to 8:00 AM, and on 12/31/24 from 12:00 PM to 4:00 PM. Interview on 01/02/25 at 4:30 PM, Staff A verified the findings.”

“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: 32088 Based on medical record review, policy review and staff interview, the facility failed to ensure a bedfast patient was repositioned to prevent the development of pressure ulcers and failed to ensure a bath was offered daily as per policy. This affected one of five patients reviewed for pressure ulcers (Patient #1). The facility’s census was 22. Findings include: Review Patient #1’s medical record revealed an admission date of 08/28/24 with a diagnosis of acute respiratory failure with hypoxia and quadriplegia after falling and breaking his neck. The patient also had a history of chronic obstructive pulmonary disease and liver cirrhosis. Review of the patient’s history and physical, written on 11/28/24 by the physician, Staff E, revealed the patient came to the hospital for complex medical treatment, to wean the patient from the ventilator, and wound therapy. The doctor noted the patient had several pressure ulcers present on admission and consulted wound care. A skin assessment was completed on 08/28/24 and the patient had five wounds: one to the scrotum, one to the sacrum, one on both gluteal folds, and one to his right fifth toe. Review of Patient #1’s medical record revealed the patient was to be repositioned every two hours and to keep the heels elevated or in pressure relief boots. On 08/28/24 the sacral wound measured 1.5 centimeters (cm) by 0.1 cm by 0.15 cm. On 08/29/24 the sacral wound was reassessed and measured 3 cm by 2 cm by 0.1 cm. Review of Patient #1’s flow sheets revealed the patient was not repositioned and/or the feet were not elevated or in protective boots on 09/02/24 from 7:01 AM through 3:59 PM, on 09/04/24 from 6:01 AM through 6:59 PM, on 09/05/24 from 5:01 AM through 9:59 AM, on 09/06/24 from 6:01 AM through 6:59 PM, on 09/09/24 from 4:01 AM through 9:59 AM, on 09/11/24 from 8:01 AM through 6:59 PM, on 09/12/24 from 10:36 AM through 6:59 PM, on 09/13/24 from 8:01 AM through 09/14/24 at 5:59 PM, on 09/15/24 from 6:01 AM through 7:59 PM, on 09/18/24 from 10:01 AM through 5:59 PM, on 09/25/24 from 12:01 PM through 7:59 PM, on 09/26/24 from 1:01 PM through 09/27/24 at 4:59 PM, On 09/28/24 at 6:01 AM through 6:59 PM, on 10/01/24 at 6:01 AM through 10/02/24 at 6:59 PM, on 10/04/24 at 5:01 AM through 10/05/24 at 9:59 AM, on 10/05/24 from 6:01 PM through 10/06/24 at 8:29 AM, on 10/07/24 at 5:01 AM through 10/08/24 at 12:29 AM, on 10/08/24 at 5:01 PM through 10/09/24 at 11:59 PM, on 10/09/24 at 3:48 PM through 10/10/24 at 6:59 AM, on 10/12/24 at 7:01 AM through 7:59 PM, on 10/16/24 at 4:50 PM through 10/17/24 at 6:59 AM, on 10/20/24 at 6:01 PM through 10/23/24 at 7:00 AM, on 10/24/24 at 7:01 AM through 6:59 PM, on 10/25/24 at 5:01 AM through 6:59 PM, 10/26/24 at 6:01 AM through 7:59 PM, on 10/29/24 at 6:01 AM through 7:59 PM, on 10/31/24 at 6:01 PM through 11/01/24 at 6:59 AM. On 09/05/24 and 09/12/24 the sacral wound measured 3 cm by 3 cm by 0.1 cm. On 09/19/24 the sacral wound measured 4 cm by 5 cm by 0.1 cm. On 09/26/24 the sacral wound measured 4 cm by 6 cm by 0.1 cm. On 10/17/24 and 10/24/24 the sacral wound measured 2 cm by 3 cm by 0.1 cm. On 10/31/24 the sacral wound measured 5 cm by 3 cm by 0.1 cm. On 10/31/24 the patient developed one pressure ulcer to each heel. The right pressure ulcer measured 5 cm by 5 cm by 0.1 cm. The left heel pressure ulcer measured 6 cm by 6 cm by 0.1 cm. Further review of the flow sheets revealed the patient did not receive a bath on 09/01/24, 09/04/24, 09/13/24, 10/01/24, 10/07/24 and 10/09/24. Review of the facility policy titled “Clinical Guidelines and Protocols,” revised on 10/01/24, revealed patients should be bathed daily and bedfast patients should be repositioned every two hours. These findings were verified during interview on 01/02/24 at 1:20 PM with Staff D.”