Healthcare Inspection – Staffing and Patient Care Issues, West Palm Beach VA Medical Center, West Palm Beach, Florida

OIG conducted an inspection in response to complaints about staffing and patient care issues in the medical intensive care unit (MICU) at the West Palm Beach VA Medical Center (facility), West Palm Beach, FL. We substantiated the allegation that nursing management had an inappropriate understanding of the staffing methodology in the MICU. We did not substantiate that insufficient staffing in the MICU caused orders to be missed or delays in blood transfusions. We substantiated that understaffing in the MICU contributed to an increase in patient falls. We did not substantiate that two falls resulted in patient injury. We substantiated that frequent floating of the MICU staff contributed to the departure of several experienced registered nurses (RN) and that frequent floating and assignment changes of MICU staff occurred. We substantiated the allegation that nursing staff were sent to areas where they did not feel competent. We did not substantiate the allegation that, to prevent the use of overtime, a staff member who was still being oriented was required to sit with suicidal patients. We did not substantiate that insufficient staffing caused difficulty in covering additional duties of MICU RN staff. We did not substantiate that the step down unit was frequently closed. We substantiated that one RN was left alone in the step down unit on four occasions. We did not substantiate that the RN had to leave the patients unattended. We found that the facility’s process for reporting incidents was not set-up to ensure that incidents were reported as required. We also found that the facility policy for prevention of falls was not being followed. We made four recommendations.