HospitalInspections.org

Based on observation, Hospital policy and document review, and staff interview, it was determined the Hospital failed to assure 3 of 3 (Employee #s 26, 27, and 28) contracted nursing staff sampled met the Hospital's hiring qualifications. Findings include:

Hospital policy titled "Supplemental Caregivers" for the Nursing Department stated, "...Purpose: To outline the process for use of Supplemental Caregivers in the provision of nursing care...While the Staffing Agreement requires the Staffing Agency to only present candidates for contracted staff positions which meet the requirements of ChristianaCare (e.g., background clearances...) ChristianaCare must convey and confirm such requirements with the staffing agency prior to the confirmation of the assignment...At a minimum, any contracted staff RNs [registered nurses] must hold a current...adult and child abuse registry check clearances..."

Hospital contract titled "Managed Services Provider Agreement" between AMN Healthcare, Inc. ("AMN") and Christiana Care Health Services, Inc. ("Client") effective January 12, 2023 stated, " ...Prior to confirmation of assignment of Clinical Contract Staff, AMN will contractually require each Affiliate Vendor to comply with the background check qualifications..."

Review of hiring documentation for Employee #s 26, 27, and 28 revealed no evidence that a State of Delaware Adult Abuse Registry clearance and a State of Delaware Child Protection [Child Abuse] Registry clearance was completed.

This finding was confirmed with Employee #2 on 11/1/23 at 2:15 PM.

Based on observation, Hospital policy and document review, and staff interview, it was determined the Hospital failed to assure nursing staff adhered to hand hygiene policy during 1 of 2 medication administrations observed. Findings include:

Hospital document titled "Job Specification Registered Nurse II" stated, "Administers medications in a safe and effective manner ...Performs assigned work safely, adhering to established CCHS and departmental safety rules and practices ..."

Hospital policy titled "Hand Hygiene, Handwashing/Alcohol Hand Sanitizer" stated, " ...Hand hygiene will be performed ...during patient care as needed ...hand hygiene should be performed ...after contact with inanimate objects (including medical equipment) in the patient environment ..."

During observation of IV (intravenous) medication preparation and administration on 10/20/23 between 11:42 and 11:55 AM, Employee #12 was observed:

- performed hand hygiene and donned gloves
- opened 2 IV tubing packages
- removed IV antibiotic bag seal, and inserted IV tubing into bag
- removed IV normal saline flush bag seal and inserted IV tubing into bag and primed tubing
- carried IV bags and supplies into patient's room and placed on table top
- moved IV pump to patient's bedside, hung IV bags onto IV pump
- cleaned IV port on the normal saline flush bag and inserted IV antibiotic tubing into cleaned port
- loaded IV antibiotics into IV pump
- identified patient and scanned patient identification bracelet
- cleaned patient's IV port and flushed
- attached IV antibiotic to patient's port and secured
- collected used supplies and disposed of properly in "Sharps" container and trash can
- removed gloves and performed hand hygiene

Nurse did not change gloves and perform hand hygiene after contact with the IV pump and before proceeding to clean the IV port on the normal saline flush bag.

Employee #12 confirmed this finding during an interview on 10/30/23 between 11:55 and 11:58 AM.

Based on medical record review, Hospital policy and document review, and staff interview, it was determined that the Hospital failed to ensure adherence of their medication administration policy for 1 of 8 inpatient patients (Patient #1) sampled. Findings include:

Hospital policy titled "Medication Administration: stated, "...Administration Medication Schedule...Notify the provider if a scheduled dose is omitted or postponed...Nurses are responsible for administering medications scheduled during their shift..."

Hospital document titled "Job Specification Registered Nurse I and II stated, "...Administers medications in a safe and effective manner..."

Patient #1

Review of the medical record revealed:

- Physician orders dated 10/24/23 at 10:45 AM documented order for Heparin 5,000 units subcutaneous every 12 hours due to moderate venous thromboembolism risk.
- Medication Administration Record documents Heparin 5,000 units was not administered on the following dates and times resulting in 11 omitted doses:
10/24/23 8:47 PM; refused
10/25/23 8:00 AM; patient/family refused
10/25/23 8:00 PM; patient/family refused
10/26/23 8:00 AM; patient/family refused
10/26/23 8:00 PM; patient/family refused
10/27/23 8:00 PM; patient/family refused
10/28/23 8:00 AM; patient/family refused
10/28/23 8:00 PM; patient/family refused
10/29/23 8:00 AM; patient/family refused
10/29/23 8:00 PM; patient/family refused
10/30/23 8:00 AM; patient/family refused
- No evidence that provider was notified of any of the omitted doses of Heparin.

During an interview on 10/30/23 between 2:50 and 3:45 PM, Employee #s 2 and 30 confirmed there was no evidence that the provider was notified of the 11 omitted doses of Heparin.