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Based on record reviews, interviews, and review of the hospital's policy,"Chest Tube: Care of the Patient", Registered Nurse (RN) #8 and #9 failed to ensure nursing assessments and vital signs were documented when Patient #4's chest tube became disconnected from the drainage system on 11/06/2022 and on 11/07/2022 when the chest tube accidentally dislodged from the patient's chest.
The findings included:

On 11/15/22 at 8:35 AM, review of Patient #4's nursing note dated 11/6/22 at 1:30 AM revealed the registered nurse called the hospitalis to inform the physician that the patient's chest tube had disconnected from the suction system. On 11/17/22 at 7:35 AM, RN #8 stated the chest tube had disconnected from the drainage tubing at about 1:30 AM. When asked if a nursing assessment was documented for incident, RN #8 reported he/she was not sure. When RN #8 was asked how he/she reconnected the tubing back to the drainage tubing, RN #8 stated that she/he saw the drainage tubing disconnected in the bed so she/he connected the drainage tubing back to the patient's chest tube. RN #8 stated she/he did not clean or disinfect the tubing before reconnecting the tubing back to drainage. When asked what disinfectant the hospital's procedure required when a chest tube disconnected from drainage, RN #8 stated she didn't know. Review of Patient #4's nurse notes with RN #8 revealed there was no nursing assessment documented when the chest tube dislodged on 11/6/2022 at approximately 1:30 AM. Vital signs were documented on 11/5/22 at 9:28 PM and on 11/6/22 at 4:27 AM. The finding was verified with the Director of Inpatient Services and RN #8 who reviewed Patient #4's nurse notes. On 11/17/22 at 11:30 AM, the Director of Inpatient Services reported that he/she was not sure what the hospital's procedure required when a chest tube became disconnected. On 11/17/2022 at 11:30 AM, the Regulatory Manager reported the hospital's policy and procedure did not have an approved antiseptic/disinfectant to use when a chest tube became dislodged. The issue was referred to the Manager of Infection Control who stated to follow the manufacturer's guidelines, but the manufacturer's guidelines did not identify any specific disinfectant to use for this purpose.

Review of Patient #4's chart on 11/15/22 at 8:35 AM revealed RN #9 documented on 11/7/22 at 3:34 PM that the patient's chest tube was removed. On 11/16/22 at 2:05 PM, RN #9 was asked if a nursing assessment was performed when the patient's chest tube was removed accidentally on 11/7/2022. RN #9 stated, "I did do a nursing assessment. I listened to the patient's lungs, and the patient's continuous pulse oximeter showed the patient was satting okay." Review of the nurse notes dated 11/7/2022 with RN #9 revealed no nursing assessment was documented when the chest tube dislodged.

Review of Patient #4's chart revealed there was no registered nurse assessment for the 7pm - 7am shift on 11/4/2022. On 11/16/22 at 12:02 PM, the Director of Patient Services stated nursing assessments should be documented every shift. The Director of Patient Services stated that RN #7, an agency nurse, was assigned to the patient on 11/4/2022 for the 7pm - 7am shift. On 11/15/22 at 3:15 PM, the 4th floor Charge Nurse revealed chest tubes should be assessed every shift (every 12 hours), and chest tube drainage should be documented every 8 hours. On 11/16/22, the 4th floor Nurse Manager reported chest tubes should be assessed every shift (every 12 hours), and chest tube drainage should be documented every 8 hours.

On 11/15/22 at 12:28 PM, review of the hospital's policy, "Chest Tube: Care of the Patient", revealed under Procedure that "---2. Assessment: Priority in the care of a patient who has a chest tube: 2.1. ..... Accidental Removal...Chest tube inadvertently removed from patient's thorax...Prevent air from entering the tube insertion site by covering it with a gloved hand or woven fabric (i.e. 4 x(by)4 gauze), ...Assess patient for tension pneumothorax...Notify physician...Chest tube becomes disconnected from the collection drainage system...Insert the separated chest tube into sterile water until it can be reattached and secured to the drainage system... Prior to reattachment, wipe connection points with facility approved antiseptic solution and immediately reconnect the tubes...Assess patient for tension pneumothorax...Notify physician...".

Based on observations, interviews, and review of the hospital's policies, entitled, "Hand Hygiene" and "Transmission Based Precautions", one of three Registered Nurses (RN) and one of two physicians observed failed to follow procedures to limit the potential spread of infectious agents in the hospital setting. Registered Nurse (RN) #1 failed to perform hand hygiene after touching a garbage can and prior to hanging a Normal Saline solution and performing a saline flush for 1 of 1 patient. Physician #1 failed to don a gown when entering a patient's room and assessing the patient who was on contact precautions for Respiratory Syncytial Virus (RSV). The physician failed to disinfect/clean the stethoscope used to assess the patient and hung the stethoscope around his/her neck, and exited the patient's room.


The findings included:

RN #1
Observations on 11/14/22 at 10:20 AM revealed RN #1 in the provision of care for Patient #1 in room 409. Observations showed RN #1 touched the inside surface of the patient's garbage can, and then moved the IV (Intravenous) pole closer to the patient's bed. Then, without removing his/her gloves or performing hand hygiene, RN #1 attached IV tubing to a bag of IV Normal Saline and hung the Normal Saline. Observations showed RN #1 used a syringe of Normal Saline to flush the patient's IV saline lock before hanging the bag of fluids. During an interview on 11/14/22 at 10:31 AM, the surveyor reviewed the observations with RN #1 who verified the finding. On 11/14/22 at 10:35 AM, review of the hospital policy, entitled, "Hand Hygiene", revealed hand hygiene is performed after touching the patient's surrounding including equipment or devices and before a clean or aseptic procedure.

Physician #1
Observations on 11/14/22 at 11:40 AM revealed Physician #1 entered Room 408 for Patient #2 who was ordered contact/sputum precautions for Respiratory Syncytial Virus (RSV). Physician #1 did not wear a gown. Physician #1 spoke with the patient, removed the stethoscope from around the neck, and auscultated the patient's chest. Then, Physician #1 placed the stethoscope around his/her neck and exited Room 408 without disinfecting the stethoscope.
During an interview on 11/14/22 at 11:44 AM, Physician #1 was notified of the observed infection control concerns when the patient is on RSV contact/sputum precautions. Physician #1 stated she/he did not wear a gown because she/he did not touch anything in the room. Physician #1 verified the observations, and stated his/her usual practice is to put a glove over the stethoscope bell to prevent contamination and did this. The physician did not disinfect the stethoscope after patient use. With the stethoscope still draped around the neck, Physician #1 stated she/he was going into the chart room to document the patient's assessment. The Contact Precautions sign on the door to Room 408 revealed "...Wear gown if going into the room past the arc of the opening door...Use dedicated or disposable equipment or disinfect shared equipment between patients...".

On 11/14/22 , review of the hospital's policy, entitled, "Transmission Based Precautions", revealed, "...Non-dedicated equipment and items are disinfected with hospital approved disinfectant prior to use with another patient....PPE in Contact Precautions...Gloves and gowns are required for entry into the patient room as described: ...The healthcare worker..., without PPE, does not enter the room past the line created by the "arc of the door" when the door to the room opens, or does not enter past the curtain line in rooms with privacy curtains...".