By Walter F. Roche Jr.
A patient at UPMC Mckeesport was found unresponsive in mid-December after an unidentified employee failed to notice that the batteries on the physician ordered cardiac monitor were depleted.
According to the report from the Pennsylvania Department of Health the incident occurred on Dec. 13. The patient was attached to the monitor at 12:30 p.m. and was found unresponsive at 1:26 p.m., according to the report.
The incident marks the second time in less than two months that a UPMC hospital has been cited for cardiac monitor failures. UPMC Presbyterian Shadyside was cited for a similar incident in late October.
In the McKeeesport case the report states that the employee not only failed to note the battery was depleted but waited for more than an hour to even apply the leads to the patient, who had been sent out for tests.
As a result of the findings, the state agency declared a state of "immediate jeopardy," which forces the facility to come up with an immediate plan to avoid a recurrence.
The report states the immediate jeopardy declaration was issued "when it was identified that a staff member did not follow facility policy by allowing a patient to remain disconnected from a cardiac monitoring leads on Dec. 13 at 11:20 a.m."
The leads were reappplied at 12:30 p.m."with the batteries depleted."
The unidentified worker acknowledged to the state that she did not notice the batteries were depleted.
Hospital spokesman Rick Pietzak said the facility had filed a plan of correction which was accepted by the state, but he did not respond a series of questions about the incident.
In the October event at UPMC Presbyterian Shadyside it took staff six hours before they realized a patient had been disconnected from a physician ordered cardiac monitor.
The unnamed patient's monitor stopped functioning at 10:13 p.m. on Oct. 26. But the patient was not found unresponsive until 4:14 a.m. the next day.
Contact: wfrochejr999@gmail.com
Monday, February 22, 2021
Monday, February 8, 2021
Another Suicide in Temple Psych Unit
By Walter F. Roche Jr.
Citing four serious incidents, including two suicides in an eight month period, state Health officials are calling for the board and other top officials at the Temple University Hospital to take control of a troubled behavioral care unit.
In a report just made public state Health surveyors concluded the board "failed to provide the necessary supervision and oversight" at the psychiatric unit resulting in "patterns of serious events and infrastructure failures."
In the latest incident in December a patient who was being discharged from the Crisis Response Center at the Episcopal campus, committed suicide by jumping out a third floor window.
The suicide followed two incidents of aggressive behavior by the patient. When an employee triggered an emergency call for assistance the patient bolted away and jumped out a window.
Through interviews and reviews of videotapes the surveyors reconstructed the incident including the decision of one of the hospital employees to issue an emergency assistance call.
"It was determined that the facility failed to provide the necessary care to ensure a safe discharge from the CRC," the report states.
According to the report hospital employees failed to follow the hospital's own procedures for handling incidents of aggresive behavior.
One employee who was involved in the incident said the patient did not respond when he told him he was going the wrong way.
"I was behind the hallway door and I heard glass breaking, which made me speed up," the employee said.
The report notes that none of the staffers contacted the patient's doctor as they should have.
Another employee told the Health Department officials that a group of employees should have escorted the patient after the aggressive behavior was displayed.
In its plan of correction the hospital said the board was informed of the incident and physically toured the area.
The plan includes the hiring of an outside consultant to draw up a series of recommendations.
The plan also includes the installation of plexiglass and stationing a security guard in the discharge area.
The report notes the previous incidents including the patient who committed suicide by hanging and another incident where a patient who was allowed to keep his cigarette lighter subsequently started a fire in an emergency department hallway.
Hospital officials did not respond to a series of questions about the incident.
Contact:wfrochejr999@gmail.com
Citing four serious incidents, including two suicides in an eight month period, state Health officials are calling for the board and other top officials at the Temple University Hospital to take control of a troubled behavioral care unit.
In a report just made public state Health surveyors concluded the board "failed to provide the necessary supervision and oversight" at the psychiatric unit resulting in "patterns of serious events and infrastructure failures."
In the latest incident in December a patient who was being discharged from the Crisis Response Center at the Episcopal campus, committed suicide by jumping out a third floor window.
The suicide followed two incidents of aggressive behavior by the patient. When an employee triggered an emergency call for assistance the patient bolted away and jumped out a window.
Through interviews and reviews of videotapes the surveyors reconstructed the incident including the decision of one of the hospital employees to issue an emergency assistance call.
"It was determined that the facility failed to provide the necessary care to ensure a safe discharge from the CRC," the report states.
According to the report hospital employees failed to follow the hospital's own procedures for handling incidents of aggresive behavior.
One employee who was involved in the incident said the patient did not respond when he told him he was going the wrong way.
"I was behind the hallway door and I heard glass breaking, which made me speed up," the employee said.
The report notes that none of the staffers contacted the patient's doctor as they should have.
Another employee told the Health Department officials that a group of employees should have escorted the patient after the aggressive behavior was displayed.
In its plan of correction the hospital said the board was informed of the incident and physically toured the area.
The plan includes the hiring of an outside consultant to draw up a series of recommendations.
The plan also includes the installation of plexiglass and stationing a security guard in the discharge area.
The report notes the previous incidents including the patient who committed suicide by hanging and another incident where a patient who was allowed to keep his cigarette lighter subsequently started a fire in an emergency department hallway.
Hospital officials did not respond to a series of questions about the incident.
Contact:wfrochejr999@gmail.com
Thursday, February 4, 2021
Covid-19 Continues to Hit PA Veterans Homes
By Walter F. Roche Jr.
Cases of the coronavirus have continued to hit Pennsylvania's six veterans homes with 119 new cases reported since early January.
Data provided by the state Department of Military and Veterans Affairs shows that the number of Covid-19 deaths in the six facilities has also increased with the total jumping by 10 to 109 in the same period.
Nine of those new deaths were at the Gino Merli Veterans Center in Scranton while there was one additional death at the Pennsylvania Soldiers and Sailors Home in Erie.
There were no new deaths at the Southeastern Veterans Center in Chester County, but that facility already had the highest number of deaths at 42.
Eighteen deaths rom the virus have ocurred at the Delaware Veterans Center in Philadelphia while 17 deaths from the virus have been reported at the Hollidaysburg Veterans Center.
Nineteen Covid deaths were reported at the Erie home while three were reported at the Southwestern Veterans Center in Pittsburgh.
The biggest increase in new cases of coronavirus among residents was reported at Hollidaysburg where 71 new cases were reported since January. The second highest number of new cases during the one month period was at the Scranton home where 44 residents contracted the virus during that same one month period.
Data from the state agency shows the cases of coronavirus among staff at the six homes also have increased from 402 in January to 486 this month.
Contact: wfrochejr999@gmail.com
Cases of the coronavirus have continued to hit Pennsylvania's six veterans homes with 119 new cases reported since early January.
Data provided by the state Department of Military and Veterans Affairs shows that the number of Covid-19 deaths in the six facilities has also increased with the total jumping by 10 to 109 in the same period.
Nine of those new deaths were at the Gino Merli Veterans Center in Scranton while there was one additional death at the Pennsylvania Soldiers and Sailors Home in Erie.
There were no new deaths at the Southeastern Veterans Center in Chester County, but that facility already had the highest number of deaths at 42.
Eighteen deaths rom the virus have ocurred at the Delaware Veterans Center in Philadelphia while 17 deaths from the virus have been reported at the Hollidaysburg Veterans Center.
Nineteen Covid deaths were reported at the Erie home while three were reported at the Southwestern Veterans Center in Pittsburgh.
The biggest increase in new cases of coronavirus among residents was reported at Hollidaysburg where 71 new cases were reported since January. The second highest number of new cases during the one month period was at the Scranton home where 44 residents contracted the virus during that same one month period.
Data from the state agency shows the cases of coronavirus among staff at the six homes also have increased from 402 in January to 486 this month.
Contact: wfrochejr999@gmail.com
Tuesday, February 2, 2021
Staff Shortages Reported at 2 PA Hospitals
By Walter F. Roche Jr.
Surveyors from the Pennsylvania Health Department have recently reported that two hospitals had staff shortages and those shortages impacted patient care.
At the First Hospital of the Wyoming Valley surveyors reported that the hospital "failed to ensure they employed adequate staff to provide adequate active treatment.
The reports come at a time when many medical facilities are reporting layoffs and cutbacks in the wake of the Covid-19 pandemic.
Officials at Lehigh Valley Hospital Pocono did not respond to requests for comment.
Annmarie Poslock, spokeswoman for First Hospital said the hospital filed a plan of correction which was accepted by the state.
"We have secured additional staffing resources to support treatment for the patients in our care," she stated.
The report on First Hospital noted that four senior inpatient therapist slots were unfilled and that the director of social services did not meet the qualifications to hold that position.
"The hospital must employ or undertake to provide adequate numbers of qualified profesional, technical and consultative personnel to provide active treatment measures," the report states.
At Lehigh Valley Pocono the report focuses on the lack of adequate registered nurses, including one day when three nurses were left to provide care for 28 patients. Six should have been on duty, the report states.
The staffing shortage, the surveyors found, resulted in three patients facing lengthy delays in getting needed medications. One patient didn't get the precribed medication till the next day.
The records reviewed showed that there were extensive delays in repositioning bedbound patients. One patient who was supposed to be repositioned every two hours was not repositioned for 12 hours.
In a plan of correction filed with the state hospital officials said they would offer bonuses in an ongoing efort to fill staff vacancies. The plan also includes so-called ambulance diversions to slow the flow of patients to the emergency room.
The report cites the failure to monitor the blood pressure of an emergency room patient and the failure to provide food to five ER patients.
On multiple dates, the surveyors found, the facility failed to have a trauma certified registered nurse on duty in the emergency room.
Hospital records showed some emergency room patients gave up and left without even being seen. On Dec. 4 15 patients gave up and left without being seen.
Other cases cited include a lengthy delay in tending to a patient who had fallen off a bike headfirst.
In its plan of correction the hospital said it would take steps to ensure adequate staff. Contact: wfrochejr999@gmail.com
Surveyors from the Pennsylvania Health Department have recently reported that two hospitals had staff shortages and those shortages impacted patient care.
At the First Hospital of the Wyoming Valley surveyors reported that the hospital "failed to ensure they employed adequate staff to provide adequate active treatment.
The reports come at a time when many medical facilities are reporting layoffs and cutbacks in the wake of the Covid-19 pandemic.
Officials at Lehigh Valley Hospital Pocono did not respond to requests for comment.
Annmarie Poslock, spokeswoman for First Hospital said the hospital filed a plan of correction which was accepted by the state.
"We have secured additional staffing resources to support treatment for the patients in our care," she stated.
The report on First Hospital noted that four senior inpatient therapist slots were unfilled and that the director of social services did not meet the qualifications to hold that position.
"The hospital must employ or undertake to provide adequate numbers of qualified profesional, technical and consultative personnel to provide active treatment measures," the report states.
At Lehigh Valley Pocono the report focuses on the lack of adequate registered nurses, including one day when three nurses were left to provide care for 28 patients. Six should have been on duty, the report states.
The staffing shortage, the surveyors found, resulted in three patients facing lengthy delays in getting needed medications. One patient didn't get the precribed medication till the next day.
The records reviewed showed that there were extensive delays in repositioning bedbound patients. One patient who was supposed to be repositioned every two hours was not repositioned for 12 hours.
In a plan of correction filed with the state hospital officials said they would offer bonuses in an ongoing efort to fill staff vacancies. The plan also includes so-called ambulance diversions to slow the flow of patients to the emergency room.
The report cites the failure to monitor the blood pressure of an emergency room patient and the failure to provide food to five ER patients.
On multiple dates, the surveyors found, the facility failed to have a trauma certified registered nurse on duty in the emergency room.
Hospital records showed some emergency room patients gave up and left without even being seen. On Dec. 4 15 patients gave up and left without being seen.
Other cases cited include a lengthy delay in tending to a patient who had fallen off a bike headfirst.
In its plan of correction the hospital said it would take steps to ensure adequate staff. Contact: wfrochejr999@gmail.com
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