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Based on observation, record review and interview, the hospital failed to ensure a registered nurse supervised and evaluated the nursing care of each patient as evidenced by 1) failing to administer sliding scale insulin per physician's order (Patient #1), 2) failing to notifiy the physician of high blood glucose results (Patient #3) and 3) failing to perform wound care per physician's order (Patient #5).
Findings:

1) Failing to administer sliding scale insulin per physician's order (Patient #1)

Review of the electronic medical record for Patient #1 revealed an admit date of 05/23/2023 and discharge date of 05/31/2023. The patient had diagnoses including diabetes.

Review of physician admission orders revealed to obtain accuchecks (blood glucose) before meals and at bedtime with Humalog insulin to be administered per sliding scale orders. Review of the sliding scale revealed the patient was to be administered Humalog insulin if the blood glucose reading was 150 and above.

Further review of the patient's record revealed blood glucose readings above 150 on the following dates:
05/26/2023 at 12:00 p.m. - result of 248
05/26/2023 at 5:00 p.m. - result of 179
05/27/2023 at 12:00 p.m. - result of 225
05/28/2023 at 12:00 p.m. - result of 264
05/29/2023 at 5:00 p.m. - result of 217
05/31/2023 at 11:30 a.m. - result of 216
There was no documented evidence that the patient received any sliding scale insulin during his hospital admission.

On 08/08/2023 at 9:30 a.m., S1DON reviewed the patient's electronic medical record and confirmed there was no documentation indicating that the patient received any sliding scale insulin on the above dates as ordered by the physician.


2) Failing to notify the physician of high blood glucose results (Patient #3)

Review of the electronic medical record for Patient #3 revealed an admission date of 07/18/2023 and discharge date of 07/31/2023. The record revealed diagnoses including diabetes.

Review of physician admission orders, dated 07/18/2023, revealed to perform accuchecks (blood glucose) before meals and at bedtime and administer Humalog insulin as needed per sliding scale. Review of the sliding scale revealed that for blood sugars over 401, 10 units of Humalog insulin should be administered and to notify the MD.

Review of the record revealed the patient had blood glucose readings above 401 on the following dates:
07/19/2023 at 11:30 a.m.- result of 491
07/20/2023 at 11:30 a.m. - result of 405
07/21/2023 at 4:30 p.m. - result of 452
07/25/2023 at 11:45 a.m. - result of 427
There was no documented evidence that the MD was notified of the above blood glucose readings above 401.

On 08/08/2023 at 10:00 a.m., S1DON reviewed the patient's electronic medical record and confirmed there was no documented evidence that the physician was notified of the above high blood glucose readings, as ordered.

3) Failing to perform wound care per physician's order (Patient #5).

Review of the electronic medical record for Patient #5 revealed an admission physician order, dated 08/03/2023, to clean toes with dermal wound cleanser and pat dry. Apply triple antibiotic ointment to open areas and moisturizing lotion to calluses. Cover open areas with nonstick gauze and secure and change twice daily.

On 08/07/2023 at 3:10 p.m., observation revealed S5LPN performed wound care to Patient #5. Observation revealed S5LPN applied Manuka Honey wound gel to the patient's open areas on the toes. S5LPN did not use triple antibiotic ointment or moisturizing lotion as ordered by the physician.

On 08/08/2023 at 1:50 p.m., interview with S1DON confirmed that physician orders for wound care were not followed by S5LPN.

Based on observation, record review and interview, the hospital failed to have an effective infection prevention and control program as evidenced by 1) failing to have a clean and sanitary environment and 2) failing to disinfect the glucometer after use on a patient.
Findings:

1) Failing to have a clean and sanitary environment

On 08/07/2023 at 3:00 p.m., observation of Unit A revealed the following:
- Room a had brown substances on the floor. The floor in the bedroom and bathroom was very sticky. There was a large build up of soap scum in the shower.
- Room b had dirt and debris on the floor. The bedroom floor was sticky. A brown substance was on the floor of the shower and the shower had a large build up of grime and soap scum.
- Room c had a large build up of dirt and debris at the bottom of all baseboards. There was a dried white substance on the sides of the wooden bed frame.
- Room d had a brown substance on the floor and a green dried substance on the wall behind the bed. An old EKG electrode was stuck to the wall behind the bed. The shower had a large build up of dirt and grime.

On 08/07/2023 at 3:30 p.m., observation of Unit B revealed the following:
- Room e had two old EKG electrodes stuck to the frame of the bed located near the window. The other bed had a large wad of black hair on the bedspread. There was a brown substance on the floor that was easily scraped off by the surveyor's shoe. The bathroom had brown splatters on the wall, a brown substance on the back side of the commode seat and multiple black hairs in the shower.
- Room f had a very sticky floor. There was a brown substance on the floor, as well as trash/debris on the floor next the bed by the window. There was a brown substance on the bathroom floor and a large build up of soap scum and grime in the shower.

On 08/07/2023 at 3:55 p.m., observation of the day room on Unit B revealed six chairs that the patients were sitting in had multiple areas with old dried food and debris on them.

On 08/07/2023 at 4:00 p.m., interview with S2Housekeeper revealed that she had just completed the daily cleaning of all the above patient areas.

On 08/08/2023 at 2:00 p.m., interview with S1DON and S3CEO revealed that they were aware of the issues with housekeeping in the hospital. S3CEO stated they were in the process of hiring more housekeeping staff.

2) Failing to disinfect the glucometer after use on a patient

On 08/07/2023 at 11:15 a.m., observation revealed S4LPN entered the day room and placed a plastic container containing a glucometer and blood testing supplies on the table in front of Patient #2. S4LPN was observed to don gloves and check the patient's blood glucose with the glucometer. After using the glucometer on the patient, S4LPN placed it back into the plastic container with the clean blood testing supplies, left the day room while still wearing the contaminated gloves and opened the door to the nurses station while wearing the gloves. S4LPN then entered the medication room, where she then placed the container on the counter and washed her hands. S4LPN was not observed to disinfect the glucometer prior to exiting the medication room to perform other tasks.

Review of the policy titled Basic Disinfection, revealed in part that low level disinfection is used for items such as blood glucose meters. The policy did not indicate what type of disinfectant or the procedure for disinfecting the glucometer.

On 08/08/2023 at 3:30 p.m., interview with S1DON confirmed that the hospital policy was not specific as to the type of disinfectant to use or the procedure for disinfecting the glucometer. S1DON further confirmed that the glucometer should be disinfected with "purple top" wipes after use on each patient.