HospitalInspections.org

Based on observations and interviews with staff, the hospital failed to ensure the privacy of patients in the psychiatric area. The findings include:

A tour of the emergency department's psychiatric area was conducted on 5/5/10 at 10 AM with the Director of Nursing. Two computer monitors were noted at the nursing desk in areas visible from the hallways. The monitors contained live footage of each patient in the psychiatric area, without providing privacy for those patients.

Based on tour and observation for one patient who was receiving medication, the facility failed to ensure the patient's privacy. The findings include:

During tour of the on the E3-PCU nursing unit, an observation identified a medication cart that was unattended. On the top of the cart a computer screen was open so that confidential patient information was displayed and could be observed by anyone passing in the hallway. Once identified, the nurse manager closed the computer screen on the medication cart.

Based on clinical record reviews and interviews with facility personnel for one of four sampled patients (Patient #87), the facility failed to ensure that a skin assessment was completed upon admission.

The findings include:

1. Patient #87 was admitted to the hospital on 3/2/10 for oncology care. The nursing admission assessment dated 3/2/10 identified that the patient's Braden assessment was 19 (low risk) and that his/her skin was intact. Further review identified that two additional skin assessments were completed on 3/2/10-3/3/10 and indicated that the patient had no skin issues. Review of the wound consult dated 3/3/10 identified that the patient had a Stage III pressure ulcer to the right ear measuring 0.5cm x 0.4cm x <0.1cm and a Stage III pressure ulcer to the left ear measuring 0.4cm x 0.2cm x 0.1cm and Stage I's to the buttock and heel areas. Further review failed to reflect that the pressure ulcers had been identified upon admission. Review of hospital policy identified that every patient receives a full inspection of skin on admission and each shift. Any impairment of skin is noted in the electronic medical record. Interview with the wound care nurse on 5/10/10 identified that the patient's pressure ulcers were identified when the hospital was doing rounds for their prevelence study and a complete skin assessment was not done on admission.

Based on clinical record review, review of hospital policies, and interviews with staff for one patient (Patient #86) who required a special diet and specific feeding techniques, the hospital failed to ensure that the care plan addressed the patient ' s specific dietary needs. The findings include:

Patient #86 was admitted on 3/10/10 with a diagnosis of infected dermatitis. A physician ' s order dated 3/10/10 directed staff to provide the patient with a moist ground thin liquid diet and to feed the patient foods and fluids with a spoon. Per policy, the patient was placed on a dysphagia II diet. Review of the patient ' s care plan dated 3/10/10 identified the patient was to be assisted with meals and feeding, but failed to identify the patient ' s need to be fed liquids with a spoon. Interview with the Director of Risk and the Nurse Manager on 5/6/10 at 1:15 PM identified that the hospital ' s process was to document the patient ' s special dietary needs on a piece of paper and hang the paper above the patient ' s bed. Patient Care Tech (PCT ' s) do not have assignments that indicate the type of care each patient required, but were expected to follow the directions on the paper above the bed. However, staff were unable to verify that Patient #86 had the directions posted above the bed. In addition, the clinical record failed to identify that PCT ' s and/or family members were instructed on dietary and feeding instructions, unique to the patient and failed to identify that family members were observed and deemed appropriate to feed the patient.

Based on clinical record review and interviews with staff for one patient (Patient #86) who had a special diet order, the hospital failed to ensure that documentation of the patient ' s special dietary needs was accurate. The findings include:

Patient #86 was admitted on 3/10/10 with a diagnosis of infected dermatitis. A physician ' s order dated 3/10/10 directed staff to provide the patient with a moist ground thin liquid diet and to feed the patient foods and fluids with a spoon. According to the hospital policy for specialized diets, the patient was placed on a Dysphagia II diet. The clinical record was reviewed with the VP of Patient Care on 5/10/10 at 9:30 AM. Between 3/10/10 and 3/19/10, staff inconsistently and inaccurately documented the type of diet that the patient received. The diets that were documented were Dysphagia I, Dysphagia II, and/or Dysphagia III. On 3/18/10 at 5:58 PM, Patient #86 was identified as being fed a regular diet with a regular consistency.

Based on clinical record review and interviews with staff for one patients (Patient #84) who had nutritional needs, the hospital failed to ensure that recommendations of the dietician were considered and/or implemented. The findings include:

Patient #84 was admitted on 4/29/10 with a diagnosis of malignant pleural effusion. A Dietitian's nutrition assessment was conducted on 5/4/10. The patient was identified as consuming 25 to 75% of each meal, and dietary recommendations identified that Patient #84 was to trial Ensure twice a day and to consider initiating a multivitamin and appetite stimulant. The clinical record was reviewed with the Nurse Manager and Dietitian on 5/5/10 at 1:30 PM. The record failed to reflect that Ensure was trialed and failed to identify that a physician considered the recommendations including the multivitamin and appetite stimulant. Interview with the Dietitian on 5/5/10 at 1:30 PM identified that he/she should have initiated an order for the Ensure on 5/4/10 but didn't, and there was no clear process to follow to alert a physician regarding dietitian recommendations.

Based on tour and observation in the outpatient physical therapy department, review of hospital policy and interviews with hospital personnel, the hospital failed to ensure that hospital equipment was properly maintained. The findings include:

1. Tour of the outpatient physical therapy department identified that temperatures were out of range for several pieces of equipment: the parafin warmer (118-121 degrees from 5/9/10-5/10/10; acceptable range: 123-134 degrees), the splint pan (128-130 degrees from 4/23/10-4/26/10 and 176 degrees from 5/9/10-5/10/10; acceptable range: 140-160 degrees) and the hydrocollator machine (150s for the month 4/11/10-5/10/10, acceptable range: 160-170 degrees). Review of hospital policies failed to reflect the action to be taken in the event that the equipment temperatures were not within range.

Based on tour of the Operating Suite on 5/5/10, review of hospital policy and interview with hospital personnel, the hospital failed to ensure that infection control practices were followed. The findings include:

a. During tour of the operating rooms (OR) with the Director of Peri-Opertive Services, the scrub area located between OR #1 and OR #2 was observed to lack access to a clock to time scrubs. Review of the hospital policy for Scrubbing directed that the first scrub of the day included a one (1) minute preliminary wash followed by rinsing, cleaning of nails and then a five (5) minute scrub using appropriate technique. During interview on 5/5/10, the Director of Perioperative Services stated that the clock was removed during renovation and was not replaced.

b. Numerous rooms were observed to contain a clutter of pre-packaged supplies located on open shelving, above anesthesia machines and attached to machines, which failed to allow cleaning of the OR between cases and terminally according to hospital policy. Review of the hospital policy for Housekeeping in the Operating Room and interview with the Director of Peri-Operative Services, identified that all horizontal surfaces of furniture and equipment should be damp dusted with an approved disinfectant before the first case of the day and between cases.

c. During observation of the cleaning of an OR between cases on 5/5/10 at 10:28 AM, portions of the OR table that were on the floor propped against a table were reassembled without the benefit of washing the pieces prior to placing linen on the bed. Interview with the OR staff member identified that she thought this was acceptable since the pieces had been washed prior to placing them on the floor. Interview with the Director of Peri-operative Services identified that such practice was not acceptable.

d. Observation of the cleaning of the OR on 5/5/10, identified that the staff applied the disinfectant solution Virex II (256) with a moistened cloth to furniture surfaces. The OR table was wiped down to look wet, however, air dried within one minute. Review of the manufacturer's recommendations for the application of the disinfectant identified that the solution should remain wet on the surface for 10 minutes to ensure bactericidal action against most microbes.

e. Observation of staff persons throughout the OR during surgical procedures identified that the hood provided (that tied under the chin) was often tied behind the head, failing to enclose the hair in back of the head. Additionally, although many staff members wore the bouffant cap, those caps were observed to slide back on the head, exposing hair on the front of the head. Review of the hospital policy for OR Attire identified that the expectation was that all hair was to be completely covered. During interview on 5/5/10, the Director of Peri-operative Services identified that she expected all OR staff to be cognizant of appropriate hair covering.



19952

Based on tour and observation in the Outpatient Wound Center, review of facility policy and interview with facility personnel, the hospital failed to ensure that infection control practices were followed. The findings include:

1. Tour of the the Outpatient Wound Center, review of hospital information and interview with the Clinical Coordinator on 5/10/10 identified that two hyperbaric chambers were cleaned with disinfectant (Tor HB) once per week. Review of the Department Specific Infection Control Policies for the Wound Management Clinic and interview with the Infection Control Nurse indicated that the hyperbaric chambers would be disinfected with Tor HB on the chamber interior, stretcher and mattress after each patient use.

Based on a review of medical records, interview with hospital personnel and review of hospital policy, the hospital failed to ensure that medication administered during procedures and/or surgery was documented. The findings include:

Review of the Anesthesia Records of Patients #96, #97, #98 and #99, who underwent endoscopic procedures on 5/5/10, identified that each patient received the medication propofol for sedation, however, the dose administered failed to be recorded on the Anesthesia Record. During interview on 5/10/10, the Chief of Anesthesia stated that he would expect that the dose of medication administered during the procedure would be recorded on the Anesthesia Record. Review of the Rules and Regulations for the Anesthesia Department identified that accurate recording of medications administered should be completed on the Anesthesia Record.