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2800 MAIN ST

BRIDGEPORT, CT 06606

PATIENT RIGHTS: PERSONAL PRIVACY

Tag No.: A0143

Based on observations and staff interview for 1 of 3 sampled patients reviewed for privacy, the hospital failed to ensure privacy was provided during an examination of a patient and failed to ensure that a patient video monitoring screen was not visible to other patients or visitors in the behavioral health unit of the Emergency Department. The findings include:

a. Observations of the Emergency Department (ED) on 1/13/2020 at 1:36 PM identified a patient in the C-Zone on a stretcher parked in the hallway. A portable privacy curtain was noted at the head of the stretcher. Further observation identified a physician examining the patient and the patient starting to remove their shirt and then stopped. The physician was observed to hand the patient a cup and the patient got off the stretcher and walked towards the bathroom. Interview at that time with RN Manager #1 and the Director of Clinical Services stated that if the patient is being examined in the hallway, privacy curtains are to be around the patient to maintain their privacy.

b. Observation on 1/13/2020 in the ED behavioral health unit identified within the nursing station a video monitor screen of all six patient rooms that was visible from outside the nursing station. Further observation identified no privacy screen was on the monitor. Interview with RN Manager #1 and the Director of Clinical Services at that time identified that there is a sign posted in the changing room and above the door before you enter the unit. RN Manager #1 stated that staff don't tell the patients that they are being monitored and it is not documented in the clinical record. RN Manager #1 acknowledged there was no privacy screen on the monitor and that the screen was visible from outside the nursing station.

PATIENT RIGHTS: CARE IN SAFE SETTING

Tag No.: A0144

Based on observations and staff interview for 4 of 4 patient units toured for environmental safety, the facility failed to ensure the units were free of ligature risks and free of areas/items that could be used for self-harm. The findings include:

Observations during a tour of the South unit on 1/14/2020 at 9:50 AM identified at the nursing station an opening in the glassed partition and within reach of this opening was an electric pencil sharpener, cords from the computer, mouse and monitor, all which were easily accessible for a patient standing at the glass partition. On the Center unit in the common area was a VCR (Video Cassette Recorder) and cords that were not secured and was able to be pulled out. The North unit nursing station had a glass partition with an opening at the base and the cords from the computer and mouse and virtual desktop were easily accessible to patients standing outside the glass.

Interview with the Head of Maintenance at that time stated the areas of concern that were identified during the tour of the units were being corrected.

NURSING CARE PLAN

Tag No.: A0396

Based on observation, interview, and review of the clinical record for 1 of 4 patients (Patient #9) reviewed for cardiac services, the facility failed to ensure the patient had a comprehensive care plan. The finding includes:

Patient #9 was admitted on 1/9/20 with diagnoses including substance abuse and syncopal episode.
The physician's History and Physical dated 1/9/10 identified the patient was admitted to the ICU (Intensive Care Unit) for persistent hypertension and tachycardia in setting of recent stimulant use (cocaine and ecstasy).

The care plan identified the patient was at high risk for falls. Interventions included increase supervision and assist during high fall risk activities.

Review of the clinical record and interview with Director #1 and Manager #3 on 1/14/19 at 10:40 AM failed to identify a comprehensive care plan was in place for Patient #9. Although the care plan did address the patient was at risk for falls, the care plan failed to address any other patient problems with interventions, or discharge planning. Manager #3 identified the electronic medical record software suggests the care plan for the patient based on the patient's problems and the nurse should initiate the care plans as appropriate. Manager #3 identified Patient #9's care plan could have been more patient focused, and care plans for drugs and alcohol, and self-care could have been initiated.

The facility nursing process policy identified that based on initial and ongoing assessment of a patient, an appropriate plan of care is developed in collaboration with clinical disciplines and the patient and family. Any interdisciplinary plans of care (IPOC) that are suggested need to be initiated and other IPOC's need to reviewed and initiated if pertinent to the patient's specific condition and nurses should customize initiated IPOC's with patient specific interventions and outcomes.

SECURE STORAGE

Tag No.: A0502

Based on observation, interview, and policy review, for 1 of 10 patient units reviewed for medication storage, the facility failed to ensure medications were properly secured. The finding includes:

Patient #4 was admitted on 12/26/19 with diagnoses that included sepsis and respiratory failure.

Tour of the ICU on 1/13/20 at 10:35 AM with Director #1 and Manager #2 identified that IV medications including propofol (IV sedative), ampicillin, epinephrine, and norepinephrine were unsecured on top of a cart in Patient #4's room. The nurse was not present in the room.

Interview with RN #2 on 1/13/20 at 10:35 AM identified he left the medications in the room when he went to check on another patient.

Interview with Director #1 identified the medications should not have been left unsecured in a patient room.

The facility policy identified storage of medications on inpatient units shall be in the designated secured medication room, in the individual patient bins, pyxis, and in the secured cabinet at the nursing station if applicable.

DIETS

Tag No.: A0630

Based on observation, clinical record review, interview, and policy review, for 1 of 3 infants (Patient #15) reviewed for diet, the facility failed to ensure the patient was fed per physician orders. The finding includes:

Patient #15 was born on 1/13/20 at 9:35 PM. The physician's order dated 1/13/20 directed breastfeeding on demand per the breastfeeding and lactation policy.

Interview and review of the clinical record with Manager #4 on 1/15/20 identified the patient was fed 20 milliliters (ml) of infant formula at 4:00 AM and 30 ml of infant formula at 5:15 AM on 1/15/20. Manager #4 identified a physician's order is required to feed an infant formula.

The facility breastfeeding and lactation policy identified formula will not be part of the standard orders for newborn care and will only be given to infants per physician's order.

PHYSICAL ENVIRONMENT

Tag No.: A0700

The Condition of Participation for Physical Environment has not been met.

Based upon a tour of the hospital, the facility failed to ensure that the Behavioral Health Nursing Units on the 9th floor at St. Vincent's Medical Center were designed and maintained in such a manner as to promote the safety and well-being of patients.

Please see A701, A724 and A749

MAINTENANCE OF PHYSICAL PLANT

Tag No.: A0701

Based upon a tour of the hospital, the facility failed to ensure that the Behavioral Health Nursing Units on the 9th floor at St. Vincent's Medical Center were designed and maintained in such a manner as to promote the safety and well-being of patients. The findings include:

On 01/13/2020 at 10:25 AM and times throughout the survey, the surveyor, while accompanied by the Plant Facility Engineer and the Facility Safety Director observed the following:

a. The corridor bathroom/shower had a fire alarm horn/strobe device that was located on the wall and was not securely fastened and protected;

b. There were wall hanging pictures located in the sitting room that were not securely fastened;

c. The patient sleeping rooms throughout the unit had ceiling grid and tiles that were removable and not securely fastened to prevent ligature risk;

d. The patient sleeping rooms and bathrooms were equipped with ceiling mounted smoke detectors that were unprotected from removal;

e. The patient sleeping rooms were equipped with HVAC vents that were not securely fastened to prevent ligature risk and loose at the time of survey.

f. On 01/13/20 at 11:25 AM the surveyor, accompanied by the Director of Facilities, observed that the "teller window opening" at the Nurses' stations security windows were designed and installed in such a manner as to enable unauthorized access to electrical cords, office supplies, and office equipment.

g. On 01/13/20 at 10:25 AM the surveyor, accompanied by the Director of Facilities, observed that the fire sprinkler heads within the Children's Unit North #2 lounge are not institutional style heads that would be consistent as to the application in a Behavioral Health Unit.

h. On 01/13/20 at 10:00 AM the surveyor, accompanied by the Director of Facilities, observed that the corridor between Rooms #173 and #175 lacked a handrail.

All the above posed a potential ligature risk or potential injury hazard and were not designed or maintained to psychiatric institutional standards or guides; i.e. units shall be properly safeguarded from patients and permanent safety measures are required to be applied.



27249

FACILITIES, SUPPLIES, EQUIPMENT MAINTENANCE

Tag No.: A0724

Based on observation, interview, and review of facility policy for 1 of 2 labor and delivery operating rooms, the facility failed to ensure supplies were maintained per facility policy and for 3 of 11 crash carts, the facility failed to ensure the checklist was completed daily. The findings include:

a. Tour of the Labor and Delivery cesarean section room on 1/15/20 at 10:30 AM with Manager #4 identified 2 bottles of sterile water dated 11/22 with black marker and 1 bottle saline dated 11/22. Manager #4 removed the fluids and identified the person stocking the supplies should have written the expiration date for 60 days after the date the fluids are stocked in the warmer on the bottle. Manager #4 identified they have a new employee who may have written the manufacturers expiration date for fluids stored at room temperature rather than warmed fluids.

The facility fluid warming policy identified solutions placed in the fluid warmer will be predated 60 days in advance for irrigation in semi-rigid containers.


b. Observations during a tour of the ED on 1/13/2020 and 1/15/2020 identified 3 of the 11 crash carts (emergency supplies and equipment) with missing documentation of the code cart checks.

The Zone A code cart and defibrillator checklist for January 2020 identified on 1/5/2020 the code cart check, tag number and defibrillator check were blank.

The Zone D (Pediatric) code cart and defibrillator checklist for January 2020 identified on 1/12/2020 the code cart check and tag number was blank.

The Zone E code cart and defibrillator checklist for January 2020 identified on 1/3/2020 and 1/12/2020 the code cart check, tag number and defibrillator check was blank.

Interview with ED RN Manager #1 on 1/15/2020 at 11:50 AM stated that the code cart and defibrillator are to be checked daily to ensure proper functioning of medical equipment and to ensure the tag (security locking mechanism) is in place (to ensure integrity of the cart items).

INFECTION CONTROL PROGRAM

Tag No.: A0749

1. Based on observation, review of facility documentation, and interview with the Director of Facilities, the facility failed to ensure that a water management plan was in place and reviewed annually to reduce Legionella risk in the healthcare facility water systems to prevent cases and outbreaks of Legionnaires' disease (LD) as required by 42 CFR §483.80 for skilled nursing facilities and nursing facilities. The finding includes:

On 01/15/20 at 09:55 AM the surveyor was not provided with documentation by the Director of Facilities to indicate facility had a required comprehensive water management plan in place and annually reviewed, not meeting the requirements of the referenced standard. i.e.; last documented review was last conducted in 2017.


37002

2. Based on observation, clinical record review, interview, and review of facility policy for 1 of 3 patients (Patient #8) reviewed for transmission based precautions, the facility failed to ensure proper signage was in place to direct staff to wear the appropriate personal protective equipment. The finding includes:

Patient #8 was admitted on 1/10/20 with diagnoses that included upper GI bleed, anemia, and contact transmission based precautions.

Tour of the 6th floor unit with Director #1 and Manager #3 on 1/14/19 at 9:45 AM identified a narrow adhesive banner (tape) across the door identifying the patient was on isolation. The signage failed to identify what type of isolation the patient was on to direct staff regarding what PPE (personal protective equipment) to wear to prevent the transmission of microorganisms.

Interview with Director #1 and Manager #3 identified there should be a sign on the door to identify the type of transmission based precautions to direct the staff to wear PPE. Director #1 identified the facility policy is to hang an additional sign on the door that identifies the type of transmission precautions in addition to the adhesive banner identifying that the patient is on isolation.

The facility isolation precaution policy identified transmission based precautions are for patients suspected to be infected by epidemiologically important pathogens including airborne, droplet, contact, and contact plus precautions. A precautions sign will be mounted on the door identifying the type of precautions. The policy directs staff will wear gowns and gloves when entering a room of a patient on contact precautions, a respirator mask for airborne precautions, and a mask and face shield for droplet precautions.