HospitalInspections.org

Based on observation, interview and record review, the hospital failed to ensure the hospital evaluated the care for one of 12 sampled patients (1) when the nursing staff failed to transcribe dressing change orders to a Medication Administration Record, Treatment Record or a Nursing Care Plan. This failure had the potential to result in a lack of timely dressing changes to Patient 1's multiple wounds.

Findings:

1. During an observation on 1/11/13 at 11:30 AM, Patient 1 was observed in an air bed with three undated dressings intact. Patient 1 had multiple skin lesions to the arms and legs with a white cream applied to them. Also, he had multiple small open areas to the coccyx (tailbone) with white cream applied.

During a review of the clinical record for Patient 1, the Skin Care Guidelines dated 12/18/12 at 1 PM, read "Dressing Changes every 3 days and as necessary. . . skin ulcers cover with foam, Gangrene toes cover with Xeroform gauze and change daily."

During an interview with Nurse Manager 1 on 1/11/13 at 3:30 PM, he reviewed the clinical record and was unable to find documentation that Patient 1's dressing changes and wound assessment had been done every three days. Upon further review he was unable to find the order placed on the Medication Administration Record, the Nursing Care Plan or a Treatment Record. He stated, "I would expect to find the order on the Medication Administration Record and the assessment of the dressing changes in the patient's Care Notes."

The hospital policy and procedure titled, "Standards of Care, Assessment", dated 1/09, read "Skin will be assessed for any abnormal discoloration, bruising, itching or rashes.... The presence of pressure ulcers will also require measurement of the size with dressing change of the ulcer and location. Interventions must be documented in the nursing notes."

Based on observation and interview, the hospital failed to implement policies and procedures to reduce the risk of developing infections, which had the potential for spreading infection to the hospital ' s patient population and staff.

Findings:

During an observation of the fourth floor Medical Surgical Department in Patient 1's room on 1/11/12 at 11:30 AM, a small trash can was overflowing with used yellow isolation gowns and gloves. On a shelf right above the dirty gowns were two wash basins with dressing supplies for Patient 1's multiple dressing changes. One pink plastic bin contained a box of gauze dressings that were open to the environment, an open package of medicated gauze dressings next to a visibly soiled ace wrap dressing, and other various patient care items. This pink basin was stored directly below an alcohol based handwashing dispenser, creating a source for cross-contamination. The second pink wash basin also contained various dressing packages that had been opened, and were exposed to the environment, and were stored under a container of sanitary wipes containing a bleach solution for surface cleaning.

During a concurrent interview with the Director of Infection Control, she was asked about the storage of the dressing supplies and the dirty gowns and gloves. She stated, "This is not acceptable and will be taken care of right away."