HospitalInspections.org

Based on observation, medical record review, staff interview and review of hospital policies & procedures, the hospital failed to ensure intravenous tubing was changed according to the standard of practice for 2 of 4 sample patients (#7, #12) who had intravenous fluids ordered. The findings were:

1. Observation on 6/19/14 at 1:45 PM revealed patient #12 had continuous intravenous (IV) fluids running. Further review showed the (IV) tubing was not dated as to when it required changing. Interview with the unit manager on 6/19/14 at 1:55 PM verified the tubing was not dated and it should have been. Review of the hospital policy on Intravenous Therapy, CLIN-MM-24, revised 2/1/12, page 2, instructs:"Change primary continuous administration sets every 72 hours and PRN [as needed]." Because this patient's IV tubing was not dated, it was unknown when it should have been changed.

2. Review of the medical record for patient #7 showed an IV was placed on 5/13/14 at 8:20 PM but was not removed until 5/16/14 at 11:57 PM. Review of the medical record showed it was not continuous but intermittent for piggyback administration. Review of the hospital policy on Intravenous Therapy, CLIN-MM-24, revised 2/1/12, page 2, instructs:"Change primary intermittent and piggyback administration sets every 24 hours." This patient's IV tubing was not changed for 53.5 hours. Interview with the unit manager on 6/19/14 at 1:55 PM verified the IV tubing should have been changed every 24 hours.

Based on staff interview and medical record review, the hospital failed to ensure infection control precautions were addressed in the care plan for 2 of 11 sample patients (#2, #4). The findings were:

According to Mosby's Manual of Diagnostic and Laboratory Tests by Pagana & Pagana, Eleventh Edition, 2013, page 258, Clostridium difficile is an infection in which..."The Disease severity can range from mild nuisance diarrhea to severe pseudomembranous colitis and bowel perforation." The following concerns were identified:
a. Review of the admission diagnosis showed patient #4 had an admission diagnoses including Clostridium difficile. Review of the entire nursing care plan for this patient showed infection control issues were not addressed.
b. Review of the admission diagnosis showed patient #2 had an admission diagnosis of Clostridium difficile. Review of the nursing care plan showed no evidence infection control issues were addressed.
c. Interview with the RN #1, on 6/18/14 at 10:30 AM, verified neither patient had infection control precautions addressed in their care plans. Further, interview with infection control practioner #1 on 6/19/14 at 3:10 PM revealed she would expect infection precautions to be included in the care plan for patients with any type of infectious disease that required precautions.