Based on review of facility policy, medical record (MR) and staff interview (EMP), it was determined the facility failed to meet the emergency needs of a patient in accordance with acceptable standards of practice for one of 11 medical records reviewed (MR1). Findings include: A review of facility policy "Children's Hospital Standard of Care" effective December 2016, revealed, "...f. Ongoing patient assessment includes the following: Vital Signs...Temperature...For heating/cooling devices: Minimum of every 2 hours when a patient is under a heating lamp, warming blanket, or cooling blanket. If not contraindicated, patients requiring warming/cooling blanket should have continuous temperature monitoring rectal or foley probe in place...." A review on April 12-13, 2017, of MR1 revealed the patient arrived in the Emergency Department on January 10, 2017, at 2:51 PM, with a temperature of 89.4 degrees F, rectally. A Bair Hugger (blanket warmer device) was applied to the patient. The following patient temperatures were obtained rectally: 90.8 F at 8:16 PM, 92.8 F at 9:14 PM, 97.8 at 10:44 PM, and 98.0 F at 12:14 AM on January 11, 2017. There were no other temperatures documented until 10:22 AM on January 11, 2017. The patient's rectal temperature at that time was 107.6 F. A review of physician inpatient note addendum dated January 13, 2017, revealed "...We came and saw him in ED around 10 AM. There were no vitals and his last temp was around midnight. The nurse during the rounds told us him temp was now 42 C {107.6 F}. We asked about the bair hugger and it had been on high all night. ..." An interview conducted on April 13, 2017, at 9:40 AM with EMP19 confirmed that the temperatures were not documented in the medical record. EMP19 stated "I know I took temps. I was in the room every hour doing eye drops. I must have not documented, I did not have the computer with me. I was probably busy with something else." An interview conducted on April 12, 2017, at 10:45 AM with EMP4 confirmed that no temps were documented for a "10 hour period."

Based on a review of facility policy, medical records (MR), manufacturer guidelines, and staff interviews (EMP) it was determined the facility failed to ensure their policy related to Bair Hugger warming device matched the manufacturer guidelines. Findings include: A review of facility policy "Children's Hospital Standard of Care" effective December 2016, revealed, "...f. Ongoing patient assessment includes the following: Vital Signs...Temperature...For heating/cooling devices: Minimum of every 2 hours when a patient is under a heating lamp, warming blanket, or cooling blanket. If not contraindicated, patients requiring warming/cooling blanket should have continuous temperature monitoring rectal or foley probe in place...." A review on April 12-13, 2017, of MR1 revealed the patient arrived in the Emergency Department on January 10, 2017, at 2:51 PM, with a temperature of 89.4 degrees F, rectally. A Bair Hugger (blanket warmer device) was applied to the patient. The following patient temperatures were obtained rectally: 90.8 F at 8:16 PM, 92.8 F at 9:14 PM, 97.8 at 10:44 PM, and 98.0 F at 12:14 AM on January 11, 2017. There were no other temperatures documented until 10:22 AM on January 11, 2017. The patient's rectal temperature at that time was 107.6 F. A review of warming device manufacturer's guidelines revealed, "...Precautions. Monitor the patient's temperature at least every 10-20 minutes, and monitor the patient's vital signs regularly. Reduce air temperature or discontinue therapy when the therapeutic goal is reached or it vital sign instability occurs. ..." An interview conducted on April 13, 2017, at 12:15 PM with EMP26 confirmed the facility did not follow the manufacturer's guidelines, but should have. EMP26 was not aware of the manufacturer guideline regarding monitoring the temperature at least every 10-20 minutes. EMP26 stated, "It was news to me."