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Based on record review and interview the hospital failed to provide a written response to a family member who had made a grievance to a department manager concerning the quality of care issues regarding the physical environment, infection control, nutrition, nursing care, respiratory care and patient rights issues for 1 of 5 reviewed grievances (Patient #2). Findings:

Review of the grievances submitted to by the hospital for the last three months for the Medical/Surgical Unit revealed no documented evidence a grievance had been made by the family of Patient #2 or addressed by the hospital.

In a face to face interview on 06/14/10 at 1:50pm S6, RN Manager of the Medical/Surgical Unit indicated she remembered talking to the daughter of Patient #2 right before her mother was to be discharged. Further S6 indicated Patient #2's daughter was upset because she came into her mother's room and discovered a respiratory therapist giving Patient #2 a respiratory treatment which had not been ordered. S6 indicated Patient #2's daughter wanted her to fill out an incident report immediately and wanted a copy of it before she left the hospital.

Review of an e-mail from S6 RN Manager of the Medical/Surgical Unit to S1, Director of Nursing with a copy sent to the S10, then Quality Assurance Director dated 05/14/10 revealed.... " Room is terrible, edges off sink corner top, over bed table and bedside table have edges missing, toilet seat extender did not have rubber tips, leaking faucet, floor dirty. Resp. (Respiratory) Rx (Treatment) on her and was wrong patient. She requested SOS (Incident Report) and wanted a copy of the report. Told her that would not happen but assured her it would be done. It was done by Resp. We probably need some follow-up action on this one. We are remodeling but might be a good idea to do some repairs especially to this room. Well told me that DHH would shut this room down. Daughter is a Res. Therapist and owns her own company."

Observation on 06/14/10 at 10:28am of Room "a" (the room occupied by Patient #2 during her admit to the hospital 05/11/10 - 05/14/10) revealed the following: the bed side table had broken molding with exposed particle wood with jagged edges; the laminated edges of the sink counter top were missing on one side with exposed particle wood with jagged edges; the lounge chair in the room was uneven and not level causing the chair to be unsteady; and the molding strip in the bathroom doorway was missing causing an uneven floor.

In a face to face interview on 06/14/10 at 2:45pm S1 Director of Nursing indicated a new person had been hired about a month ago in the position of Patient Advocate and would be handling all complaints and grievances. Further S1 indicated she was aware no report had been generated for Patient #2's grievance which occurred during the transition period. S1 indicated S11 Patient Advocate was still trying to address some of the things left behind from the person who had this responsibility in the past.

In a face to face interview on 06/14/10 at 3:00pm S11, Patient Advocate verified she could not find any documented evidence any communication concerning an investigation and resolution to the problems identified by Patient #2's daughter could be found. Further she indicated unfortunately it was one that slipped through the cracks during the transition period. S11 indicated her new process was to send a written letter to acknowledge both complaints and grievances as well as the required communication concerning grievances.

Based on observations and interviews, the hospital failed to ensure that patients received care in a safe and therapeutic setting by failing to ensure Room (a) on the Medical/Surgical/Oncology unit was in good repair. Findings:

Physical environment observations on 06/14/10 at 10:28am, of the Medical/Surgical/Oncology unit, revealed the following:

Room (a)
1. The bed side table had broken molding with exposed particle wood with jagged edges.
2. The laminated edges of the sink counter top were missing on one side with exposed particle wood with jagged edges.
3. The lounge chair in the room was uneven and not level causing the chair to be unsteady.
4. The molding strip in the bathroom doorway was missing causing an uneven floor.

S6, RN Director of the unit confirmed the findings at this time and indicated plans had been approved to renovate the entire unit.

Based on record review and interview, the hospital failed to ensure the registered nurse (RN) followed physician's orders for Sequential Continuous Decompression (SCD) boots, to prevent clots from developing, were applied on arrival from the recovery room to the surgical unit for 1 of 1 patients with SCDs out of a total of 7 sampled patients (#5) Findings:

The Ochsner Medical Center record for Patient #5 was reviewed. Patient #5 was admitted to the hospital on 06/11/10 with a diagnosis of bilateral femoral head avascular necrosis. A left total hip arthroplasty and a right hip femoral head core decompression was done 06/11/10. Review of the physician's orders, noted by the RN on 06/11/10 10pm, revealed a physician's order for foot pumps (SCDs) lower extremity. Documentation in the Nursing Flow Sheet revealed Patient #5 was assessed on the surgical unit on 06/11/10 at 7:50pm. Review of the entire record revealed no documented evidence the SCDs were applied.

Patient #5 was observed in bed on 06/14/10 at 11am. The SCDs were in place connected to a pump on the bed with continuous decompression in progress.

Patient #5 and his wife were interviewed face to face on 06/14/10 at 11am. The patient's wife indicated Patient #5 was brought to the unit from the recovery room around 8pm on 06/11/10 with the SCD boots in place to the lower extremities. However the pump to attach to the leads of the SCD boots was not placed on the bed the entire night and Patient #5 was without decompressions for about 8 hours. She indicated when the nurse arrived for the 7a-7p shift, on 06/12/10 she placed the pump on the bed and attached the leads of the SCD to the bump and continuous decompressions were begun.

S7 RN was interviewed face to face on 06/14/10 at 11:45am. S7 indicated SCDs are placed on the patient as soon as they come form surgery. The patient arrives on the unit with the boots in place and nurses have to attach the pump to the bed and the boot leads to the pump to begin the continuous decompressions to the lower extremities.

S6, RN Director of Medical Surgical/Oncology unit was interviewed face to face on 06/14/10 at 1:40pm. She confirmed she could not find documentation in the notes the SCDs were applied when Patient #5 arrived on the unit.

S1, Director of Nurses was interviewed face to face on 06/14/10 at 1:45pm. She indicated she would expect physician's orders for SCDs be followed.