HospitalInspections.org

Based on record review and interview, the registered nurse (RN) did not evaluate the nursing care for each patient, in that reassessments were not conducted for medication effectivity after each intervention of administering PRN (as needed) medications, citing 4 of 26 inpatients (Patient #12, #13, #18, and #33).

Findings included:

Patient #12's History and Physical (H&P) indicated admission date was on 02/12/14 for right foot wound (and possible osteomyelitis). Patient #12's Medication Administration Record (MAR) reflected "Norco 325 mg/ 5 mg" two tablets were given on 02/26/14 at 8:40 AM for pain. Patient #12 was not reassessed for the effectivity of the medication.

Patient #13's H&P indicated admission date was on 02/23/14 for respiratory failure. Patient #13's MAR reflected that on 02/25/14 and 02/26/14 at 12:05 AM on both occasions the patient was given "Tussionex 10 cc of 8mg/5mL suspension" for cough. On both dates, Patient #13 was not reassessed for the effectivity of the medication.
Patient #13's MAR reflected on 02/25/14 at 9:27 AM, 1:31 PM, and 10:15 PM, the patient was given "Phenergan 25 mg" for nausea and vomiting. Patient #13 was not reassessed for the effectivity of the medication.

Patient #18's H&P indicated admission date was on 02/20/14 for hypotension. Patient #18's MAR reflected that on 02/26/14 at 4:32 AM the patient was given "Tylenol 650 mg" for pain. Patient #18 was not reassessed for the effectivity of the medication.

Patient #33's H&P indicated admission date on 02/24/14 for acute respiratory failure. Patient #33's MAR reflected that on 02/25/14 at 12:05 AM the patient was given "Ativan injection 1 mg" for anxiety. Patient #33 was not reassessed for the effectivity of the medication.

The above findings were confirmed by Personnel #27 on 02/26/14 at 9:42 AM.

The policy and procedure "Patient Assessment" last reviewed 01/2012 page 2 required "Reassessment...3. Patients are reassessed after treatment...to determine the effectiveness of the interventions undertaken..."

Based on observations, interviews and record reviews the hospital failed to ensure the Director of Dietary Services supervised and maintained the dietary department in a responsible manner in that the following was observed during the survey:
1) 1 of 1 opened bottles of mayonnaise did not have a date of when the mayonnaise was opened or when the opened jar of mayonnaise was to expire; and a large container of sliced potatoes stored in water did not have a label with the food's name or an expiration date.
2) 1 of 1 kitchen handsinks' water temperature was below the minimum requirement of 100 degrees Fahrenheit.
3) 1 of 1 staff member (Personnel #9) dropped an opened package of lunch meat on the floor and placed the soiled package on the clean food preparation area. Personnel #9 continued to prepare food and failed to use proper hand sanitation.

Findings included:

During a tour of the facility's kitchen on the morning of 2/24/14 the following was observed:

1) Inside of the kitchen's refrigerator a jar of opened mayonnaise was observed without a label indicating a date when the jar was opened and a date of expiration. A large container of sliced potatoes in water had no label indicating the contents of the container or an expiration date. Personnel #7 confirmed the observation and had the mayonnaise and potatoes thrown away.

During a tour of the facility's kitchen on the morning of 2/25/14 the following was observed:

2) 1 of 1 of the handsinks' water temperature was 94 degrees Fahrenheit per Personnel #7 who tested the water temperature. Personnel #7 stated the sink was the kitchen's only sink that had a mixing valve. Personnel #7 confirmed the water temperature should have been at a minimum of 100 degrees Fahrenheit.

3) Personnel #9 was preparing sandwiches when she dropped a package of opened lunch meat on the floor. Personnel #9 picked up the soiled package of meat and placed it on the clean food preparation area. Personnel #9 did not remove her gloves after retrieving the soiled package of lunch meat from the floor and continued to prepare 3 sandwiches. Personnel #9 removed her gloves, placed the soiled package of lunch meat on a food scale, then returned the soiled meat package to the clean work area. Personnel #9 opened and closed a drawer, retrieved a clean pair of gloves and began to put them on without washing her hands. Personnel #7 reminded Personnel #9 to wash her hands which she did at that time. Personnel #9 donned clean gloves, rubbed her forehead with her gloved hand and proceeded to make another sandwich.

The facility's Food Service Storage policy dated 1/25/12 reflected, "...Cover all refrigerated food and date while in storage..."

The facility's Food Safety training policy dated 2012 indicated, "...CHANGE DISPOSABLE GLOVES: In-between tasks and/or food items..."

The facility's undated Providing Safe Food, Chapter 1 training materials reflected, "...Pathogens can be transferred from one surface or food to another. This is called cross-contamination. It can cause a foodborne illness in many ways...Contaminated food touches or drips fluids onto cooked or ready-to-eat food...A food handler touches contaminated food and then touches ready-to-eat food..."

33589

Based on observation, interview, and record review, the facility's infection control officer did not implement the policy governing control of infection in the Medical-Surgical (Med-Surg) Department in that:

A) 2 of 2 personnel failed to complete appropriate hand hygiene;
B) 1 of 3 personnel failed to disinfect the Workstation on Wheels (WOW) after use inside an isolation patient room; and
C) 2 of 2 personnel failed to perform appropriate hand hygiene during wound dressing changes.

Findings included:

A) During an observation of a nurse administering both oral medication and intravenous medication push (IVP) in Room 472 on 02/25/14 at 9:41 AM, Personnel #15 administered the medications, removed the gloves and began using the mouse for the computer on the Workstation on Wheels (WOW) without completing hand hygiene.

The above findings were confirmed in an interview with Personnel #15 on 02/25/14 at 9:45 AM.

During an observation of a "wound vac dressing" change in Room 672 on 02/26/14 at 9:35 AM, Personnel #11 failed to change gloves and complete hand hygiene after the removal of the dirty dressing and prior to touching the exposed tissue and bone of the contact isolation patient's right foot wound.

The above findings were confirmed in an interview with Personnel #11 on 02/26/14 at 10:00 AM.

B) During an observation of a nurse attempting to start an IV in Room 461 on 02/25/14 at 10:10 AM, Personnel #14 failed to disinfect the WOW after it's use, inside an isolation patient room.

The above findings were confirmed in an interview with Personnel #2 on 02/25/14 at 10:15 AM.

C) During an observation of wound dressing changes of Patient #18's in the Room 462 on 02/25/14 from 10:12 AM to 11:15 AM, Personnel #11 and Personnel #12 were observed changing clean gloves without appropriate hand hygiene. Personnel #11 changed clean gloves three times. Personnel #12 changed clean gloves more than three times.

The above findings were confirmed by Personnel #4 on 02/27/14 at 9:08 AM.

The policy and procedure "Hand Hygiene" last reviewed 04/2013 page 2 required "...10. Decontaminate hands after removing gloves."

The policy and procedure "Wound Care" dated 01/2012 required "...This policy applies to all rehabilitation personnel (including students and contract staff)...When treating patients with wounds...Follow...hand hygiene policy...protocols for cleaning equipment must be followed..."