HospitalInspections.org

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Based on observation, document review and interview, the facility did not ensure that the patients' right to privacy was maintained.

The presence of specific patient information in public view prevented patients from the right to privacy while receiving care in the facility.

Findings:

Observations in the facility's 2 South Unit during a tour between 10:30AM and 11:45PM on 03/15/16 identified the following:

Posted outside each room were the patients' first and last names which were visible to anyone walking in the hallway.

Medication Carts in the hallway of District 1, District 3 and District 5 had patients' first and last names visible to anyone in the hallway.

Patient Medical Records at the Nurses' Station had patients' first and last names visible to anyone in the hallway.

During an interview with Staff E (Nurse Manager 2 South) on 03/15/16 at 11:45AM, the staff member confirmed the findings.

The facility's Policy and Procedure titled "Patient Rights and Responsibilities", last revised 04/10/13, stated the following: "Peconic Bay Medical Center honors and respects the right of each patient.....to privacy while in the hospital and confidentiality of all information and records regarding your care."
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Based on observation, document review and interview, in two (2) of three (3) Code Cart observations, the facility did not ensure that expired medications and biologicals were not available for patient use.

This places patients at potential risk for receiving expired medications and biologicals.

Findings:

Observations in the facility's 2 South Unit during a tour between 2:00PM and 3:00PM on 03/15/16 identified the following:

In the Pediatric Code Cart - Four (4) expired medications were available for patient use (one {1} Normal Saline Flush, expired 08/15; one {1} Normal Saline Flush, expired 10/15; one {1} Lactated Ringers Intravenous Fluid, expired 02/16; and one {1} Sodium Chloride Intravenous Fluid, expired 02/16).

Ten (10) expired biologicals were available for patient use (five {5} syringes with safety needles, expired three {3} 02/15 and two {2} 08/15; four (4) Intravenous Module Broselow Kits, expired 05/15; and one {1} Secondary Intravenous Transfer Set, expired 02/16).

During interview with Staff D (Senior Director of Nursing) on 03/15/16 at 2:15PM, the staff member confirmed the finding.

In the Adult Code Cart - Seven (7) expired biologicals were available for patient use (three {3} pairs of sterile gloves, expired one {1} 05/15 and two {2} 02/16; one {1} Thoracentesis Tray, expired, 09/15; one {1} Pneumothorax Kit, expired 10/15; and two {2} Foley Catheter Kits, expired 02/16).

During interview with Staff D on 03/15/16 at 2:30PM, the staff member confirmed the finding.

The facility's Policy and Procedure titled "Handling of Outdated and Unusable Medications", last revised 11/13, stated the following: "Nursing or other staff approved by license to administer medications, noting outdated medications, ......, will contact the Pharmacy Department notifying that department of medications existence on his or her unit. The nursing or other licensed staff member will place the unusable medication in a special container that resides on each patient care unit in a secure and separate area tabled "Unusable Medications - Return to Pharmacy".

The facility's Policy and Procedure titled "Inventory Management", last revised 01/16, stated the following: "All expired stock will be removed from inventory and disposed of following current disposal procedure".
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Based on record review, interview and observation, the facility failed to comply with the Condition of Participation for Infection Control. This was evident by the facility's failure to ensure that staff complied with the facility's Infection Control Practices to avoid potential sources of cross contamination which increases the risk for the spread of infection.

This failure places patients at risk for potential facility acquired infections.

Findings:

The facility failed to ensure that staff followed Infection Control Policies and Procedures when providing patient care.

The facility failed to ensure that staff had the correct precaution signs posted outside two (2) Patient Isolation Rooms.

The facility failed to ensure that staff donned PPE (Personnel Protective Equipment) prior to entering an Isolation Room, removed PPE and performed hand hygiene prior to exiting an Isolation Room and wore PPE correctly.

The facility failed to ensure that staff instructed visitors on proper isolation precaution procedures.

The facility failed to ensure that staff disinfected equipment between patient use.

The facility failed to ensure that staff performed hand hygiene after glove removal.

The facility failed to ensure that staff maintained appropriate infection control practices when containing trash and removing trash from an Isolation Room.

See Tag A 749.
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Based on observation, document review and interview, in two (2) of two (2) Unit observations, the facility did not ensure that staff complied with the facility's Infection Control Practices to avoid potential sources of cross contamination.

This failure places patients at risk for potential facility acquired infections.

Findings:

Observations in the facility's ICU during a tour between 12:00 Noon and 12:25PM and 2:30PM and 3:30PM on 03/15/16 identified the following:

In Patient #6's room, a patient on Contact Precautions, the garbage pail was overflowing with trash. Staff D (Senior Director of Nursing) was observed picking the trash up from the floor and trying to place it in the pail that was already too full. With both gloved hands she pushed the trash down into the pail three (3) times, in this Isolation Room.

In the same room Staff M (Secretary Technician) was observed removing the isolation garbage bag from the trash receptacle and placing the bag on the floor. She then opened another plastic bag and placed this bag on the floor. Next she put the isolation garbage bag into the bag.

During interview with Staff M (Secretary Technician) at the time of the observation, the staff member stated "I'm going to bring the garbage to the Dirty Utility Room. I don't know if this is the correct procedure" (double bagging the isolation garbage and placing it in the Utility Room). She stated "I am trying to help".

During interview with Staff K (Infection Control Preventionist) on 03/16/16 at 9:35AM, the staff member stated "she (Secretary Technician) should have waited for Housekeeping" (to remove the garbage). The bags were on the floor, the floor is "potentially contaminated" and "the floor needs to be wiped down".

In the same room Staff N (Registered Nurse) was observed initiating a blood transfusion.

During interview with Staff N (Registered Nurse) at the time of observation, the staff member instructed the Surveyor when exiting the room to perform hand hygiene with soap and water, not to use antimicrobial hand gel. The patient is on isolation for C-Difficile.

Review of the Contact Precaution Sign outside the patient's room instructed to decontaminate hands with antimicrobial gel, when exiting the room. Staff D (Senior Director of Nursing) confirmed this finding.

Staff N (Registered Nurse) without removing her PPE (Personal Protective Equipment-gown and gloves) and performing hand hygiene, exited the Isolation Room. In the hallway attached to the patient's door Staff N rifled through the isolation box contents to obtain the correct precaution sign. Remaining in the hallway she then replaced the incorrect precaution sign with the correct precaution sign.

During interview with Staff D (Senior Director of Nursing) at the time of the observation, the staff member confirmed the breeches in infection control.

Patient #6's Medical Record identified that on 03/15/16 at 2:10AM the Physician ordered Contact Precautions for C-Difficile.

In Patient #5's room, a patient on Contact Precautions, Staff I (Respiratory Therapist {RT}) was observed leaning over the patient's bed providing patient care with her gown not tied.

Staff J (Registered Nurse) then entered Patient #5's room without performing hand hygiene and donning Personnel Protective Equipment (gown and gloves). Approximately four (4) feet in the Isolation Room, the staff member donned the PPE.

During interview with Staff D (Senior Director of Nursing) at the time of observation, the staff member stated that the Nurse "should have washed her hands".

During interview with Staff K (Infection Control Preventionist) on 03/16/16 at 9:35 AM the staff member stated that staff can don PPE up to "two (2) feet into an Isolation Room".

Observations in the facility's 2 South Unit during a tour between 11:55AM and 1:00PM on 03/15/16 identified the following:

Outside Patient #7's room there was a Droplet Precaution sign instructing anyone entering the room to don a gown, gloves and mask. The patient's wife inside the room was not wearing a mask.

During interview with Staff L (Registered Nurse) at the time of the observation, the staff member stated that the wife refuses to wear a mask. I have spoken to her a few times about the need to wear a mask. I'm going in the room to talk to her again and bring her a mask.

At the Surveyor's request Patient #7's wife was interviewed. She removed her gown and gloves and without performing hand hygiene exited the room.

During interview with Patient's 7's wife at the time of observation, she stated "I was told not to wear a mask. I would if I have to. I was told to only to wear a gown and gloves." She also stated, "I was not instructed to wash my hands" after I remove the gown and gloves.

During interview with Staff E (Nurse Manager 2 South) at the time of the observation, the staff member stated that "The patient is actually on Contact Precautions. In the morning after reviewing the patient's Medical Record I switched the Contact Precaution Sign in error to Droplet Precautions." The staff member confirmed the wrong Isolation Sign (Droplet Precautions) was outside the room.

Patient 7's Medical Record identified that on 03/14/16 at 10:29AM the patient was placed on Contact Precautions.

During observation of Staff B (Patient Care Technician {PCT}) the staff member performed a blood glucose level with a Glucometer. After disinfecting the Glucometer, she placed the machine on the contaminated Chux. She then removed her gloves, and without performing hand hygiene, exited the patient's room.

Staff B was also observed performing a blood glucose test on second patient. Once again she removed her gloves, and without performing hand hygiene, exited the patient's room.

During interview with Staff E (2 South Nurse Manager) on 03/15/16 at 12:00 Noon, she confirmed the findings.

During observation of Staff C (Registered Nurse) she obtained a manual blood pressure on a patient. Without disinfecting the stethoscope, she exited the patient's room.

During interview with Staff D (Senior Director of Nursing) on 03/15/16 at 12:40PM, the staff member stated that "the Nurse should have washed the stethoscope".

The facility's Policy and Procedure titled "Standard Precautions," last revised 02/15, stated the following: Hand hygiene must be performed "immediately after gloves are removed."

The facility's Policy and Procedure titled "Hand Hygiene", last revised 11/15, stated the following: "All personnel should wash / decontaminate their hands: Wash in / Wash out - Decontaminate hands when entering the patient's room (wash in) and when exiting the patient's room (wash out)." "For patients with C-Difficile use only soap and water to clean hands."