HospitalInspections.org

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Based on review of the undated Patient Handbook and staff interview; the Acute Care Hospital failed to include information informing the patient of their right to participate in the development and implentation of his or her plan of care. The facility census was 34 on entrance.

Findings are:

A. Review of the Patient Handbook (which provides information to all patients on admission regarding the patient rights), revealed the handbook lacked the verbiage related to the right of the patient to participate in the development and implentation of their plan of care.

B. Interview with Registered Nurse A on 10/25/18 at 10:10 AM, verified that the Patient Handbook lacked information regarding the right to participate in the development and implentation of their plan of care.

C. Interview with the Director of Clinical Effectiveness on 10/25/18 at 10:15 AM, stated, "I am unable to locate a written policy for patient rights."

Based on medical record review, staff interview and review of the facility restraint policy the facility failed to ensure 1 (Patient #9) of 2 sampled restrained patients had a written modification to the plan of care to include use of restraints. The total sample was 46. The facility census was 34. Findings are:

A. Review of the electronic medical record for Patient 9 revealed the patient had soft wrist restraints applied for protection of critical lines and tubes on 7/13/19 from 5:30 AM until discontinued at 12:00 PM. Review of the plan of care failed to identify any entries related to the use of restraints for this patient.
B. Staff interview with the Patient Safety/Accreditation Coordinator on 10/22/18 at 3:25 PM confirmed the lack of care planning related to the use of physical restraints for Patient 9.
C. Record review of the facility policy titled "Restraint and Seclusion" last revised 12/2015 states "When restraint is implemented, the patient's plan of care must be modified to reflect this change".

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Based on staff interview and record review, the facility lacked a written policy regarding the patient's visitation rights related to domestic partners (including a same-sex domestic partner). The facility census was 34 on entrance.

Findings are:

A. An interview with the Director of Clinical Effectiveness on 10/25/18 at 10:15 AM stated, "I am unable to locate a written policy for Patient Rights or a visitation policy that includes domestic partner verbiage."

B. A review of The Patient Handbook verified the lack of the domestic partner verbiage informing patients of this visitation right.

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Based on a review of the undated Patient Handbook and staff interview; the Acute Care Hospital failed to inform patients of their visitation right to include domestic partners (including a same-sex domestic partner). The facility census was 34 on entrance.

Findings are:

A. A review of the Patient Handbook lacked the information informing patients of their visitation right to include a domestic partner (including a same-sex domestic partner).

B. A review of the Patient Handbook (which provides information to all patients on admission regarding visitation information) includes; "Choose who may visit you during your inpatient stay, as well as the right to withdraw such consent to visitation at any time. Visitation privileges will not be denied on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. Visitation may be restricted in medically appropriate circumstances."

C. An interview with the Director of Clinical Effectiveness on 10/25/18 at 10:15 AM verified:
-The Patient Handbook does not contain the domestic partner verbiage to inform the patients of this visitation right.
-The facility does not have a written policy and procedure for visitation rights that includes a domestic partner.

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Based on record review, facility policy review and staff interview, the facility failed to perform/document an assessment of the death for 1 of 2 death records reviewed(Patient 10) . The total sample was 46. The facility census was 34.

Findings are:

A. Electronic Medical Record review of Patient 10's record revealed the patient was admitted on 9/29/18. Admitting diagnosis included Chronic Obstructive Pulmonary Disease (COPD - a disease involving constriction of the airways and difficulty or discomfort in breathing) and Congestive Heart Failure (CHF - heart failure). On 10/2/18 at 7:40 AM, after conferring with the patient and son, the physician signed a "Do Not Resuscitate" order. This order means the nursing staff would not make any efforts to restore breathing or heartbeat if they should cease. Review of nursing documentation revealed the assessment at 8:41 PM on 10/3/18 found the patient to be alert and oriented with a regular respiratory pattern. Vital signs were last taken on 10/3/18 at 11:17 PM. The patient's vitals were: Oral Temperature 97.7 degrees Fahrenheit, heart rate 88 (recorded on telemetry/cardiac monitor as normal sinus rhythm previously at 11 PM), Respiratory rate of 18, Blood pressure of 115/52 with Oxygen saturation of 96 % (Oxygen recorded at 3 liters/minute at 8:39 PM). The next entry is a "Notice of Expiration [death]" on 10/4/18. The Notice notes the time of death on 10/4/18 at 12:11 AM. The attending physician was notified 10/4/18 at 12:20 AM. The son was notified as well. The preliminary cause of death is listed as "Multiple organ failure". The medical record does not contain any assessment of the circumstances immediately preceding the patient's death or that respirations and heartbeat ceased.

B. Staff interview with the Patient Safety/Accreditation Coordinator on 10/22/18 at 3:30 PM confirmed the lack of nursing documentation regarding the assessment of death. The Coordinator further stated that the facility policy for death did not specify that a nurse can pronounce the death of a patient or when the physician is to be notified of the death.

C. Review of the policy titled "Care of the Dying Patient/Death of a Patient last revised 10/2011. The document states staff are to "Note time respirations and pulse cease. Note any unusual signs or symptoms which immediately preceded death. REMEMBER: Record on the patient's chart. Notify Physician."

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Based on review of the barrier isolator/sterile product preparation area (area where sterile medication preparation (IV Medications) is performed), test results in the pharmacy, review of the policy/procedure and staff interview; the facility failed to ensure Testing Company B's (An outside testing company that certifies the isolator and evaluates the ability of the pharmacy personnel to avoid contamination during the compounding of sterile preparations) compliance with USP (United States Pharmacopoeia) 797. Testing Company B did not perform 1 of the 3 required tests (Surface Sampling-samples that ensure the area was successfully cleaned and disinfected within the sterile compounding area) on the last review (4/19/18) as required by the Nebraska Revised Statute 38-2867.01 (1) for compliance with USP 797 compounding regulations. This had the potential to effect any patients needing intravenous medications prepared in the pharmacy. Facility census was 34 on the first day of the survey.

Findings are:

A. A review of Testing Company B's test results from 4/19/18 revealed that the company failed to perform the Surface Sampling test.

B. Interview with the Director of the Pharmacy on 10/25/18 at 9:30 AM verified that Testing Company B had not performed the Surface Sampling test during the 4/19/18 visit. The Director of the Pharmacy stated, "The company didn't tell us that they stopped doing that test due to several other facilities complaints about the cost. Had we known that their process had changed we would have asked them to do it." "We did have the company come on 10/16/18 and they did all the testing required, the results of the Surface Sampling test is not back yet." "We have not had any issues identified from their lack of performing the test."

C. Review of the 8/2018 policy titled "Barrier Isolator" identified that "Surface sampling will occur every six months with isolator certification as well as monthly sampling of isolator gloves."