HospitalInspections.org

21996

Based on observation, document review and staff interview the Critical Access Hospital (CAH) filed to identify potential infection control issues and implement their policies.

Findings included:

- Review of the CAH's policy titled, "Hand Hygiene", directs staff to decontaminate hands before having direct contact with patients, after contact with a patient's intact skin, after contact with inanimate objects in the immediate vicinity of the patient and after removing gloves.

- Document review of the CDC (Center for Disease Control and Prevention) Guidelines for Hand Hygiene in Healthcare Settings-2002 requires healthcare workers to wash hands after removing gloves.

- Observation on 7/8/10 at 11:00am revealed staff F entered a patient's room looked through the patient's closet, bedside table and dresser draws, exited the room, entered another patient's room to obtain a wheel chair and exited the room. Staff F failed to perform hand hygiene when entering or exiting the patient's rooms.

- Observation on 7/8/10 at 11:40am revealed staff J exited a patient's room, walked to the nurses station area, obtained some items and entered the same patient's room. Staff J failed to perform hand hygiene when entering or exiting the patient's room.

- Observation on 7/8/10 at 11:50am revealed staff G and H entered a patient's room with equipment, performed a procedure on the patient, gathered the equipment and exited the patient's room. Staff G and H failed to perform hand hygiene when entering or exiting the patient's room.

- Observation on 7/8/10 at 12:00pm revealed staff I entered the patient's room to draw blood. Staff I applied gloves, attempted to locate a vein, removed the tip of the glove from the right index finger, located a vein, drew the blood and placed it in the blood tubes, removed the gloves, gathered the equipment and exited the room. Staff I failed to perform hand hygiene when entering or exiting the room.

Staff C on 7/8/10 at 2:35pm acknowledged staff need to follow the policy and perform hand hygiene when entering or exiting the patient rooms.

21996

Based on document review and staff interview, the Critical Access Hospital (CAH) failed to assure complete medical records for six of eight emergency room (ER) clinical records reviewed (#'s 3, 4, 5, 6, 7 and 8).

Findings included:

- Review of the clinical record for patient #3 revealed an ER visit on 6/23/10. The ER nurse cleaned and bandaged the patient's wound on their left second finger and transferred the patient to the clinic. The clinical record lacked evidence of a provider's order for the treatment and transfer to the clinic.

Staff E on 7/7/10 at 8:25am acknowledged the record lacked evidence of provider's orders for the care provided.

- Review of the clinical record for patient # 4 revealed an ER visit on 6/9/10. The patient had a blood and urine laboratory test done for pregnancy and received six Tramadol 50mg (milligrams) (a pain medication) to take home. The clinical record lacked evidence of a provider's order for the laboratory tests and medication.

Staff B on 7/7/10 at 9:30am acknowledged the record lacked evidence of provider's orders for the care provided.

- Review of the clinical record for patient #5 revealed an ER visit on 6/3/10. The patient received Phenergan 50mg IM ( intramuscular) (a medication for nausea). The clinical record lacked evidence of a provider's order for the medication.

- Review of the clinical record for patient #6 revealed an ER visit on 5/24/10. The patient received one tablet of Avelox ( an antibiotic) to take home. The clinical record lacked evidence of a provider's order for the medication.

Staff D on 7/7/10 at 2:05pm acknowledged the record lacked evidence of provider orders for the medication.

- Review of the clinical record for patient #7 revealed an ER visit on 5/24/10. The patient received Simethicone ( a medication used for gas relief) 40mg and a bottle of the medication was dispensed to the patient to take home. The clinical record lacked evidence of a provider's order for the medication.

- Review of the clinical record for patient #8 revealed an ER visit on 6/23/10. The patient received care and treatment for a wound on the bottom of the right foot. The clinical record lacked a provider's signature for the verbal orders received from the provider for the care and treatment provided.

Staff B on 7/8/10 at 3:10pm acknowledged the clinical records lacked provider orders for the care, treatment and medications provided.


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