HospitalInspections.org

The Critical Access Hospital (CAH) reported an average daily census of 0.6 patients with a current census of one skilled swing bed patient and four intermediate swing bed patients. Based on observation, staff interview and policy review the CAH failed to ensure safety of food storage in one of one observed refrigerator on the inpatient unit. This deficient practice compromises the integrity of food served to patients.

Findings include:

- The CAH's policy " Recommended maximum Storage Times" reviewed on 7/15/15 at 8:00am directed, "...Fruit juices in cartons opened maximum storage 7-10 days..."

- The inpatient unit refrigerator observed on 7/14/15 at 9:25am revealed an open container of cranberry juice dated 2/3/15 (161 days), an open container of orange juice dated 6/30/15 (14 days), an open container of grape juice dated 4/28/15 (78 days), and an open container of prune juice without a date when opened.

Administrative Staff C interviewed on 7/14/15 at 9:25am acknowledged the open container of cranberry juice dated 2/3/15, an open container of orange juice dated 6/30/15, an open container of grape juice dated 4/28/15, and an open container of prune juice without a date when opened.

Certified Dietary Manager Staff D interviewed on 7/15/15 at 7:40am indicated they thought open containers of fruit juice were good for one month. Staff D acknowledged they failed to follow their policy for maximum storage of fruit juices.

The Critical Access Hospital (CAH) reported an average daily census of 0.6 with a current census of one skilled swing bed patient and four intermediate swing bed patients. Based on observation, policy review, and staff interview the CAH failed to ensure outdated drugs, and biologicals are not available for patient use for one of one crash cart, and two of two emergency rooms observed (rooms #1 and 2). This failure has the potential to affect all patients admitted to the CAH.

Findings include:

- The CHA's policy titled, " Outdated and Unusable Drugs " reviewed on 7/16/15 at 12:00pm directed, " ...the pharmacy will remove all outdated drugs from all areas of the hospital on a monthly basis (minimum quarterly) ... "

- Observation of emergency room #1 on 7/13/15 at 12:10pm revealed a cabinet with a tray containing a sterile nasal (nose) packing package with an expiration date of 4/15, and a 16 ounce bottle of Isopropyl Alcohol with an expiration date of 4/15.
- Observation of emergency room #2 on 7/13/15 at 11:40am revealed a cabinet with a bottle of Nitrostat (nitroglycerin used for chest pain) 0.4mg (milligram)tablets with an expiration date of 4/15, and one 16 ounce bottle of Isopropyl Alcohol with an expiration date of 4/15.
Registered Nurse (RN) staff G interviewed on 7/13/15 at 12:15pm acknowledged the expired medications in emergency rooms #1 and #2.

- Observation of the crash cart in the hallway between the medical unit and emergency area on 7/15/15 at 7:40am revealed a medication drawer with the following outdated medications:
One-5 milliliter (ml) vial of Isuprel (medication used to treat a rapid heartbeat) intravenous with an expiration date of 6/1/15.
Two-syringes of Dextrose 50% (sugar water) with an expiration date of 6/1/15
One-10 ml vial of Procainamide (a medication to treat an irregular heartbeat) intravenous with an expiration date of 6/1/15.

Registered Nurse (RN) staff G interviewed on 7/15/15 at 7:4am acknowledged the expired medications in the crash cart.

Pharmacy staff H, interviewed on 7/15/15 at 9:00am explained they knew the Dextrose had expired and cannot obtain any more at this time because it is back ordered and also aware the Isuprel had expired and planned on taking the issue to pharmacy and therapeutics (medical staff) committee to have the medication deleted from the formulary. Staff H was not aware of the expired Procainamide medication.

The Critical Access Hospital (CAH) reported an average daily census of 0.6 patients with a current census of one skilled swing bed patient and four intermediate swing bed patients. Based on observation, staff interview, and document review the infection control officer failed to develop an active infection control system to identify, report, investigate, monitor, and implement infection control program for staff practices which could contribute to healthcare acquired infections of patients and personnel. Observations included one of one observed steam sterilizer, one of one observed glucometer checks, and one of one observed cleaning of a discharge patient room. The CAH's failure to identify failures with infection control practices created the potential for healthcare acquired infections.

Findings include:

- The Manufacturer ' s guidelines for " Midmark " self-contained steam sterilizer reviewed on 7/14/15 at 4:40pm directed, " ...Process monitors (biological and chemical indicators) indicate if conditions in the sterilizing chamber were adequate to achieve sterilization ...Follow appropriate agency sterilization monitoring guidelines for your office. Information can also be obtained from CDC (Center for Disease Control) on monitoring programs ... "

- CDC guidelines for sterilization in healthcare facilities reviewed on 7/15/15 at 10:30am directed, " The sterilization procedure should be monitored routinely by using a combination of mechanical, chemical and biological indicators ...Biological indicators are the only process indicators that directly monitor the lethality of a given sterilization process ...Steam and low temperature sterilizers should be monitored at least weekly with the appropriate commercial preparation of spores ... "


- The Sterile Central Supply room observed on 7/14/15 at 4:45pm revealed a " Midmark " steam sterilizer. Request for the required monitoring of the sterilizers revealed the CAH failed to perform the weekly biological testing to assure accuracy of sterilization equipment.

Sterile Central Supply Staff F interviewed on 7/14/15 at 4:45pm indicated they lacked knowledge of the need to monitor the steam sterilizer for accuracy of sterilization.

Administrative Nurse Staff B interviewed on 7/15/15 at 10:30am acknowledged Central Supply staff failed to complete biological testing of the steam sterilization equipment.

- The CAH's policy "Bloodborne Pathogen Exposer Control Plan" reviewed on 7/16/15 at 12:00pm directed, "...Equipment that may be contaminated with blood or other potentially infectious materials will be examined and decontaminated before servicing or use..."

- Registered Nurse Staff E observed on 7/15/15 at 7:20am entered patient #26's room to obtain a glucometer (a machine used to test a patient's blood sugar level) test. Staff E placed a navy blue bag with equipment and supplies on the bedside table without a protective barrier. After performing the blood sugar test staff E cleaned the glucometer and placed the glucometer in the navy blue bag. Staff E then placed the navy blue bag on the sink counter and the computer tray then left patient #26 ' s room. Staff E returned the navy blue bag to the nurse's station without cleaning the contaminated bag. The failure to follow acceptable infection control standard of practice while using a point of care device in a patient room created a potential for healthcare acquired infections.

- The CAH ' s policy titled " Blood borne Pathogen Exposure Control Plan " , reviewed on 7/16/15 at 12:00pm directed, " ...Employees must wash their hands immediately (or as soon as feasible) after removal of gloves or other personal protective equipment ... "

- Housekeeping staff I observed on 7/15/15 between 8:15am to 8:40am cleaning a discharged patient room # 123 revealed staff I removed their gloves and reapplied their gloves seven times during the cleaning process of the room. Staff I failed to performs hand hygiene each time they removed their gloves and applied clean gloves.

- Housekeeping staff I, interviewed on 7/15/15 at 8:40pm acknowledged they were unaware that they needed to perform hand hygiene before and after applying gloves.

- The manufacturer ' s guidelines for the use of the disinfectant " Crew NA " toilet bowl cleaner directed, " Empty toilet bowl or urinal and apply use solution to exposed surfaces including under the rim ...Allow to stand for 10 minutes ... "
- Housekeeping staff I observed on 7/15/15 between 8:15am to 8:40am cleaning a discharged patient room #123 revealed staff I cleaning the toilet bowl with " Crew NA " disinfectant. Staff I, using a squirt bottle of " Crew NA " squirted the disinfectant into the toilet bowl, mopped the inside of the toilet bowl and flushed the toilet. Staff I repeated the process. Staff I failed to follows the manufacturer ' s guidelines for the use of the " Crew NA " disinfectant which resulted in the lack of disinfection of the toilet bowl.

Housekeeping staff I interviewed on 7/1/15 at 8:40am acknowledged they were unaware of the manufacturer ' s guidelines for the " Crew NA " disinfectant.

The Critical Access Hospital (CAH) reported an average daily census of 0.6 patients with a current census of one skilled swing bed patient and four intermediate swing bed patients. Based on medical record review, staff interview, policy review, and Medical Staff Rules and Regulation review the CAH failed to ensure one of three sampled outpatient surgical medical record containing a surgical consent (patient #35), two of three sampled outpatient surgical medical records containing a pertinent medical history and physical (Patient # ' s 31 and 32) and failed to ensure a complete medical record within thirty days for one of nineteen closed inpatient medical records reviewed (Patient #17) The CAH's medical records lack necessary information for healthcare staff involved in the care of patients to have access to information necessary to provide patient care.

Findings include:

- The CAH's Medical Staff Rules and Regulations reviewed on 7/15/15 at 3:40pm directed, " ...It is the attending physician or designee ' s responsibility to obtain the signature of the patient or his authorized representative on consent form for procedures ...A complete admission history and physical examination is to be on the patient ' s record (dictated) no more than 7 days before or 24 hours after admission ...Records of patients discharged shall be completed within 30 days following discharge..."

- The CAH ' s policy " The Patient ' s medical Record " reviewed on 7/15/15 at 3:40pm directed, " ...History and physical examinations are to be written or dictated within 48 hours after admission ...Records should be completed within 30 days of discharge ... "

- Patient #17 ' s medical record review on 7/14/15 revealed an admission date of 1/21/15 and discharged on 1/23/15. The medical record contained a discharge summary completed on 4/26/15 (93 days after discharge).
Administrative Nurse Staff B interviewed on 7/14/15 at 2:00pm acknowledged Patient #17 ' s medical record failed to be completed within the required 30 days.

- Patient #31 surgical medical record reviewed on 7/13/15 revealed an admission date of 6/30/15 for a colonoscopy (a thin, flexible tube used to look at the colon) Patient #31 ' s medical record failed to contain a history and physical completed prior to surgery. The CAH failed to ensure Patient #31 ' s medical record contained a history and physical completed within 30 days of surgery.

- Patient #32's surgical medical record reviewed on 7/13/15 revealed an admission date of 6/30/15 for a colonoscopy and esophagogastroduodenoscopy (a thin, flexible tube used to look in to the stomach). Patient #32 ' s medical record failed to contain a history and physical completed prior to surgery. The CAH failed to ensure Patient #32 ' s medical record contained a history and physical completed within 30 days of surgery.

- The CAH failed to have a policy directing staff on the required history and physical prior to surgery.

Administrative Nurse Staff B interviewed on 7/13/14 at 4:00pm acknowledged patient #'s 31 and 32 ' s surgical medical record failed to contain a history and physical.

- Patient #35 ' s outpatient closed medical record reviewed on 7/14/15 revealed an admit date of 12/8/14 for a punch biopsy of a non-healing sore on the right upper cheek. Review of patient #35 ' s medical record lacked evidence of a consent, signed by the patient for the procedure performed.
Administrative Staff B, interviewed in the conference room on 7/14/15 at 2:55pm confirmed patient #35 ' s medical record lacked consent, signed by the patient to have the physician perform the biopsy procedure.