HospitalInspections.org

Based on observation, interviews and a review of documentation, the governing body failed to appoint a chief executive officer who was responsible for managing the hospital, to include the development of all necessary policies and procedures.

Findings were:

Facility policy titled "INPATIENT MILIEU THERAPY" states, in part,
"PURPOSE:
To ensure each patient's therapeutic needs are met through a variety of therapeutic modalities.
PRACTICE STATEMENT:
...Individual and group activities are offered to facilitate optimal recovery ...
INPATIENT MILIEU THERAPY
A. Education
· Weekly nutrition education is provided by a member of the Dietary Department with a focus on the importance of nutrition in overall health. Attention is given to patients on medications known to increase lipid/glucose levels and the importance of weight control.
B. Social:
· Social skills training group is often offered several times during the week by the Social Work staff
C. Recreational:
· Leisure time activities, conducted by Occupational Therapy, are held three times weekly and include arts/crafts/games."

A review of the "8N Program Schedule" (authenticated by staff #15 on 10-15-14) revealed no evidence of weekly nutrition education, social skills training groups or leisure time activities (conducted by occupational therapy).
In an interview with staff #15 on 10-15-14 at 3:40 pm in the 8 North breakroom, staff #15 verified that no weekly nutrition education, social skills training group or leisure time activities (by occupational therapy) were being conducted on the 8 North unit.

A document titled "PARKLAND HEALTH & HOSPITAL SYSTEM CONSENT TO MEDICAL TREATMENT" states, in part,
"As a patient, you have the right to:
6) personal privacy and an environment that preserves dignity and contributes to your positive self-image.
8) confidentiality of your information and clinical records.
11) receive visitors, subject to clinical restrictions or limitations, including the right to determine who may visit."

During an observation of the 8 North unit on 10-14-14 at approximately 12:25 pm, patient #104 was waiting in the day area with a family member. Patient #104 had been discharged but was awaiting transportation. While awaiting transportation, the family member of patient #104 was able to see other patients who were currently inpatient on the 8 North unit, as there was no designated or private visiting area available.

In an interview with staff #15 on 10-15-14 at 3:40 pm, staff #15 verified that no private visiting area was available to patients when they had visitors and acknowledged that other patients on the unit were visible to any visitors, as visitation took place in the patient day area.

As no designated, private visitation area was available, other patients on the 8 North unit had no reasonable expectation of privacy when a fellow patient had a visitor.

Based on observations, interviews and a review of documentation, the hospital failed to ensure patient rights' to personal privacy was provided for 2 of 10 patients' observed on the 8 North Psychiatric Unit (Patient #55 and Patient #104). 1) MD Staff #41 and #42 discussed (Patient #55's) personal information in front of (Patient #53 and #54). 2) (Patient #104's) family was present on the unit along with other current inpatients, therefore privacy was not maintained.

Findings Included::

1) On 10/15/14 at 10:50 am observation rounds were conducted on the 8 North Inpatient Psychiatric Unit with Staff #11. The surveyor was standing behind the nursing station and overheard MD Staff #41 and #42 discussing medical information with Patient #55 in the day area. Patient #53 and Patient #54 were sitting in a chair in close proximity to MD Staff #41 and #42.

On 10/15/14 at 11:10 am the surveyor spoke with Staff #15. Staff #15 stated the physician should not be discussing Patient #55's personal information in front of other patients. Staff #15 acknowledged the personal privacy of the patient was not maintained.

The policy and procedure entitled, "Parkland Health & Hospital System Privacy Policy" with an effective date of 05/01/13 reflected, "The purpose of the policy is to ensure that Parkland and its workforce members comply with the privacy laws...Parkland requires all contractors and vendors that access, collect, create, maintain, use or disclose protected health information...to comply with all federal and state privacy laws and regulations...failure shall result in corrective actions."



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2) A document titled "PARKLAND HEALTH & HOSPITAL SYSTEM CONSENT TO MEDICAL TREATMENT" states, in part,
"As a patient, you have the right to:
6) personal privacy and an environment that preserves dignity and contributes to your positive self-image.
8) confidentiality of your information and clinical records.
11) receive visitors, subject to clinical restrictions or limitations, including the right to determine who may visit."

During an observation of the 8 North unit on 10-14-14 at approximately 12:25 pm, Patient #104 was waiting in the day area with a family member. Patient #104 had been discharged but was awaiting transportation. While awaiting transportation, the family member of Patient #104 was able to see other patients who were currently inpatient on the 8 North unit, as there was no designated or private visiting area available.
In an interview with staff #15 on 10-15-14 at 3:40 pm, staff #15 verified that no private visiting area was available to patients when they had visitors and acknowledged that other patients on the unit were visible to any visitors, as visitation took place in the patient day area.
As no designated, private visitation area was available, other patients on the 8 North unit had no reasonable expectation of privacy when a fellow patient had a visitor.

Based on observation, interview and record review, the hospital failed to ensure nursing developed and kept current a care plan which addressed a significant change for 1 of 10 patients (Patient #52) who was actively demonstrating a known side effect Akathesia (feeling of inner restlessness and inability to sit still) related to use of anti-psychotic medication.

Finding Included:

On 10/13/14 from 3:30 pm to 4:10 pm observation rounds were conducted with Staff #11 on the 8 North Inpatient Psychiatric Unit. The surveyor observed Patient #52 in the day area. Patient #52 had a Styrofoam cup in her right hand with approximately one inch of liquid in the cup. Patient #52 was constantly moving, rocking from one foot to the other. Patient #52 additionally was observed with severe hand tremors to the right hand causing the liquid in the cup to spill out of the cup onto Patient #52's hand and onto the floor. RN Staff #115 was asked by the surveyor if she was aware Patient #52 had severe tremors to the right hand. RN Staff #115 stated she had not seen any severe hand tremors today 10/13/14.

The physician progress note dated 10/09/14 timed at 07:36 pm reflected, "Motor rocking on bed, tapping foot..."

The physician progress note dated 10/10/14 timed at 08:52 am reflected, "History of Schizophrenia...easily agitated, mild drooling...Akathesia...rocking on bed, tapping foot.
The nurse psych (psychiatric) progress note dated 10/12/14 timed at 07:56 am reflected, "Patient arms noted to be shaking...patient says it comes and goes."

The physician progress note dated 10/12/14 timed at 02:06 pm reflected, "Tremor, still shifting in her chair, tapping leg and foot..."

The nurse psychiatric progress note dated 10/13/14 timed at 05:09 pm reflected, "Intensity of hand tremors variable...at 6:56 pm...sister to nursing station to say patient is drooling..."

The physician progress note dated 10/14/14 timed at 09:56 AM reflected, "Left hand pill rolling tremor (worse), still shifting in her chair, tapping leg and foot...will possibly change her medication...appears to have developed significant tremor and drooling 2/2 Risperdal..."

On 10/13/14 at 3:45 pm RN Staff #115 was asked to show the surveyor Patient #52's computerized care plan. RN Staff #115 stated the care plan did not address the side effects Patient #52 was demonstrating and/or address Akathesia a known side effect of anti-psychotic medication. RN Staff #115 stated the care plan should address Patient #52's Akathesia and side effects.

The policy and procedure entitled, "Parkland Health & Hospital System Behavioral Health Services Interdisciplinary Treatment Plan for Inpatient Psychiatry" with a revision date of 04/14/14 reflected, "The Interdisciplinary Treatment Plan shall be reviewed and updated as frequently as clinically indicated...whenever there is a significant change in clinical status...current symptoms, problems..."

Based on observation, interviews and record review, the person designated as infection control officer failed to develop and implement all necessary policies governing control of infections and communicable diseases. Failure to do so could result in the spread of infection throughout the facility.

(A) 1 of 1 washing machine on 8 North unit was not cleaned in between patients;

(B) 1 of 1 patient (Patient #71) on 5 West was on contact isolation precautions and was placed in a station next to a patient (Patient #105) who had no history of infection. There was no clear partition between the two patient stations; and

(C) 1 of 1 personnel (Personnel #55) on 5 West did not sanitize a prime bucket used by a patient. The same prime bucket was fastened to a hemodialysis machine that was already sanitized and ready for use by the next incoming patient.

Findings included:

(A) A tour of the 8 North unit on 10-14-14 revealed a laundry closet with a washer and dryer for patient use. When a cleaning schedule for the washing machine was requested, staff #114 presented the surveyor with a log book documenting once daily cleaning of the machine at approximately 11:00 pm each night but no documentation of the appliance being cleaned between patients.
In an interview with staff #114 on 10-14-14 at 11:04 am, staff #114 verified that the inside and outside of the washing machine was only cleaned daily but not between patients.
In interviews with staff #40 on 10-15-14 at 1:30 pm and on 10-16-14 at 9:56 am, staff #40 stated that there had previously been a policy and procedure in existence that provided instruction on cleaning the washing machine between patients but verified that no policy and procedure for cleaning of the washing machine was in existence currently.



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(B) During a tour of the facility's renal services unit (5 West) on 10/15/14 at approximately 12:45 PM, the following was observed:

Patient #71 occupied station #7 and was on contact isolation precautions. Patient #105 who had no history of infection occupied station #6 which was next to Patient #71. In-between the station was a curtain that was half-way drawn to separate the stations. In an interview on 10/15/14 at 1:23 PM, Personnel #52 who was the Medical Director of Renal Services was informed of the findings and the risk of cross-contamination. Personnel #52 confirmed the findings and instructed the nurse of Patient #71 to fully draw the curtains to distinctly separate the 2 stations and to prevent cross-contamination.

Policy "Guidelines for Admitting Patients with Infectious Diseases to the Hemodialysis Unit" revised 6/29/11 required "Protocol...a private room is preferred; patients colonized or infected with like organisms may share a room..."

(C) At 2:35 PM, Personnel #55, a certified clinical hemodialysis technician (CCHT) emptied a soiled prime bucket that contained used intravenous fluid (IVF). Without sanitizing the soiled prime bucket, Personnel #55 then fastened the prime bucket to a hemodialysis machine that was already sanitized and ready for use by the next incoming patient. In an interview on 10/15/14 at 2:45 PM, Personnel #55 in the presence of Personnel #54 (charge nurse) was informed of the findings. Personnel #55 confirmed the findings and stated she rinsed off the prime bucket with tap water. Personnel #54 informed Personnel #55 that prime buckets were always sanitized prior to attaching it to clean hemodialysis machines.

Policy "Unit Specific Isolation Policy" in the "Acute Dialysis Unit" reviewed 12/5/12 page 2 required "17. Cleaning and disinfection of environmental surfaces such as chairs...and containers including prime bucket...must be completed between patients..."

Based on observation, record review, and interview, the facility failed to ensure patient rooms and equipment were properly sanitized. High dust and debris were found in the Emergency Department and the Burn Unit. A neutropenic (abnormally low white blood cell count and therefore more susceptible to infection) patient was placed in a room with negative pressure, potentially exposing the patient to microorganisms of other patients and staff. Soiled patient supply cabinets and bedside commodes were found on the 8 North Psychiatric Unit. These findings have the probability to allow infection transmission to patients in the facility.

Findings include:

During a tour of the Burn Unit on 10/14/14 at 11:20am, a room (#609) that had been cleaned and ready for a patient admission was inspected. High dust was found on the exam light that would be directly over a patient. During the tour, staff #43 confirmed this finding.

During a tour of the facility on 10/15/15, patient #59 was found in room #786 with a sign that indicated the patient was neutropenic (abnormally low white blood cell count and therefore more susceptible to infection). Staff on the unit indicated the patient was in a negative pressure room (this would allow air from the hallway to be pulled into the room, potentially exposing the patient to microorganisms of other patients and staff).

Review of a document titled, "Ventilation Evaluations," dated 2/10/14, provided by the Director of Plant Operations, revealed that room #786 was a negative pressure room. The document revealed the ventilation system provided 15.5 air exchanges every hour (meaning the volume of air in the room was completely replaced each hour with air from the hallway).

During an interview on 10/15/2014 at 3:45pm, staff #40 reported the following:
-the patient in room #786 (patient #59) was neutropenic and should not have been in a negative pressure room;
-the patient was in a negative pressure room (room #786);
-the patient was being moved to the proper type of room.



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A tour of the Emergency Department was conducted at 3 pm on 10/13/14 in the company of Risk Management Staff # 113. In a trauma room, the overhead examination light which is used directly over the patient had visible dust which fell from the light when touched. Staff # 113 stated, in an in-person interview conducted during the tour of the ED, that the dust was on the overhead light and could be seen falling from the light when touched.



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During a tour of 8 North Psychiatric Unit the morning of 10/14/14, the following was observed:
· The patient supply cabinets were in need of cleaning as there was a layer of dust and dirt in the shelves of the locked patient supply cabinets; there were dried drips and splatters and sticky tape residue on the cabinet doors inside the cabinets. The cabinets contained patient supply items which were available for patient use, including bottles of shampoo, urine collection hats, gloves, sanitary napkins and socks. There was a layer of dust on the back of the countertop on the raised ledge underneath the above counters. The dirt, dust, drips, sticky residue and splatters present a risk for cross contamination of patient care items.
· In room 814, the clean utility room, there were two bedside commodes which were stacked next to the covered clean linen cart. The bedside commodes were in need of cleaning, as there was a yellow-gold 1/3" round dried drip on the toilet seat and the lower legs were dirty and rusted with dark drips. This presents a risk of cross-contamination when dirty patient medical equipment is stored in the clean utility room next to the clean linen cart.

The above was confirmed in an interview during the tour with Staff #15, Director of Psychiatry Services during the tour on the psychiatric unit the morning of 10/14/14.