HospitalInspections.org

The Critical Access Hospital (CAH) reported an average daily census of seven patients with a current census of five patients, four acute patient and one swing bed patients. Based on observation, staff interview, and policy review the CAH failed to ensure expired supplies were unavailable for patient use in one of one emergency supply bags, one of one medication rooms and one of one pediatric emergency supply carts.

Findings include:

- Lower cabinet labeled "Jump Bag" located in the Outpatient unit observed on 8/24/2015 at 1:15 PM revealed an Intubation stylet (a rod that assists with intubation (placing a plastic tube into the windpipe to maintain an open airway)) with an expiration date of 05/2012.

Registered Nurse staff D interviewed on 8/24/2015 at 1:20 PM acknowledged the expired Intubation stylet.

- Medication room in the Outpatient unit observed on 8/24/2015 at 2:15 PM revealed one light blue Protime (test used to measure blood clotting time) test tube on counter with expired date of 5/2015.

Registered Nurse staff D interviewed on 8/24/2015 at 2:15 PM acknowledged the expired test tube should have been disposed. Staff D indicated they did not know test tubes have expiration dates.

- Emergency Department Exam Room two observed on 8/24/2015 at 2:25 PM revealed two single package Culture swab packages with expired date of 5/2015.

Registered Nurse Staff E interviewed on 8/24/2015 at 2:25 PM acknowledged the expired Culture swab packages.

- Pediatric supply cart located in the Trauma Room observed on 8/25/2015 at 9:00 PM revealed one Intubating stylet package with expired date of 4/2015 and five Broselow/Hinkle Pediatric Emergency System packages (a kit containing a needle and tubing used to inject medication into the bone marrow) with expired date of 7/2015.

Registered Nurse Staff F interviewed on 8/25/2015 at 9:15 AM acknowledged the expired supplies in Pediatric crash cart.

- Policy review on 8/25/15 at 1:10pm revealed the facility failed to develop a policy to ensure proper disposal of expired supplies.

The Critical Access Hospital (CAH) reported an average daily census of seven patients with a current census of five patients, four acute patients and one swing bed patient. Based on observation, staff interview, and policy review the CAH failed to provide a clean and orderly environment in one of one procedure room observed, two of four radiology rooms and one of one physical therapy rooms.

Findings include:
Suprox-D manufacturer's information sheet reviewed on 8/24/2015 at 3:00 PM directed staff "When used as directed at 2 ozs (ounces) per gallon of water Suprox-D exhibits effective disinfectant activity... at 10 minutes contact time..."

- Housekeeping staff G observed on 8/24/2015 at 1:10 PM revealed staff G cleaning the procedure room. Staff G cleaned the floor with a Suprox-D and water mixture and immediately dry mopped the area without allowing the required 10 minute contact time as directed by the manufacturer's instructions.

Staff G interviewed on 8/24/2015 at 1:20 PM revealed the Suprox-D has a 10-minute contact time. Staff G acknowledged the Suprox-D mixture did not stay wet for 10 minutes because they dry mopped it immediately after the application.


- Oxygen tubing packaging label observed on 8/24/20/15 at 1:45 PM indicated the oxygen tubing is a single use item.


Procedure room observed on 8/24/2015 at 12:30 PM revealed open oxygen tubing connected to a wall mounted oxygen port.


Registered Nurse staff D interviewed on 8/24/2015 at 1:55 PM acknowledged the open and connected oxygen tubing in the clean procedure room. Staff D indicated the oxygen tubing should always be thrown away after each patient use.


- Fluoroscopy room observed on 8/26/2015 at 2:20 PM revealed open oxygen tubing connected to a wall mounted oxygen port.


- Computed tomography (CT) room observed on 8/26/2015 at 2:25 PM revealed open oxygen tubing connected to a wall mounted oxygen port.


Radiology staff H interviewed on 8/26/2015 at 2:25 PM acknowledged the open and connected oxygen tubing. Staff H indicated the respiratory therapy department advised them that this was acceptable.


- Physical therapy department observed on 8/26/2015 at 4:20 PM revealed one stationary bike with a torn seat, one stationary bike with the foam exposed on the seatback, and one stationary bike with tape covering the right handgrip located near the seat which made the surfaces "uncleanable".

Physical therapy staff I interviewed on 8/26/2015 at 4:30 PM acknowledged that they applied the tape to the stationary bike's handle until it can be replaced and acknowledged the stationary bikes with a tear in the seat and the bike with the exposed foam on the seatback needs to be recovered.

The Critical Access Hospital (CAH) reported an average daily census of seven patients with a current census of five patients, four acute patients and one swing-bed patient. Based on medical record review, staff interview, policy review, and Medical Staff Rules and Regulation review the CAH failed to ensure six of thirty six sampled medical records contained a pertinent medical history and physical (H & P) completed in a timely manner (Patient #'s 11, 12, 14, 15, 16, and 17) and failed to ensure a discharge summary was completed within fourteen days after discharge for three of thirty closed medical records reviewed (Patient #'s 4, 6, and 20) The CAH's failure to ensure patients' medical history and physical and discharge summaries are competed in a timely manner has the potential for poor patient outcomes.

Findings include:

- Policy titled "Medical Staff Rules and Regulations" reviewed on date 8/27/15 at 10:30am directed " ...All documentation must be completed within 14 days ... "

- Patient #4's medical record reviewed on 8/26/15 revealed an admission date of 3/3/15 with a diagnosis of femur fracture (broken leg). Patient #4's medical record revealed a discharge summary completed and signed on 4/14/15 (38 days after discharge). The CAH failed to ensure Patient #4's medical record contained a discharge summary completed within 30 days after discharge.

- Patient #6's medical record reviewed on 8/26/15 revealed an admission date of 3/14/15 with a diagnosis of diverticulitis. Patient #6's medical record revealed a discharge summary completed and signed on 4/27/15 (43 days after discharge). The CAH failed to ensure Patient #6's medical record contained a discharge summary completed within 30 days after discharge.

- Patient #11's medical record reviewed on 8/25/15 revealed an admission date of 3/28/15 admitted diagnosis Pain in limb and Hypertension (high blood pressure). Patient #11's medical record revealed the history and physical was not completed as of the review date on 8/25/15. The CAH failed to ensure History and physicals were completed within 48 hours of admission.

- Patient #12's medical record reviewed on 8/25/15 revealed an admission date of 5/8/15 admitted diagnosis Congestive Heart Failure (heart failing) and Chronic Airway Obstruction (blockage of airway). Patient #12's medical record revealed the history and physical was not completed and signed as of the review date on 8/25/15. The CAH failed to ensure History and physicals were completed within 48 hours of admission.

- Patient #14's medical record reviewed on 8/25/15 revealed an admission date of 7/27/15 admitted diagnosis Cellulitis of leg (skin infection) and Abdominal pain. Patient #14's medical record revealed the history and physical was not completed and signed as of the review date on 8/25/2015. The CAH failed to ensure History and physicals were completed within 48 hours of admission.

- Patient #15's medical record reviewed on 8/25/15 revealed an admission date of 8/4/15 admitted diagnosis Fracture rib closed, Fall, Renal insufficient (kidneys not working properly) and Cardiomyopathy (disease of the heart). Patient #15's medical record revealed the history and physical was not completed and signed as of the review date on 8/25/2015. The CAH failed to ensure History and physicals were completed within 48 hours of admission.

- Patient #16's medical record reviewed on 8/25/15 revealed an admission date of 8/21/15 admitted diagnosis Abdominal pain. Patient #16's medical record revealed the history and physical was not completed and signed as of the review date on 8/25/2015. The CAH failed to ensure History and physicals were completed within 48 hours of admission.

- Patient #17's medical record reviewed on 8/25/15 revealed an admission date of 8/22/15 admitted diagnosis of Vertigo (feeling room is spinning). Patient #17's medical record revealed the history and physical was not completed and signed as of the review date on 8/25/2015 . The CAH failed to ensure History and physicals were completed within 48 hours of admission.

- Patient # 20's medical record reviewed on 8/25/15 revealed an admission date of 5/4/2015 admitted diagnosis of Hydronephrosis (water inside the kidney) and Urinary Tract Infection (infection in bladder). Patient #20's medical record revealed a discharge summary completed and signed on 6/23/15 (51 days after discharge). The CAH failed to ensure Patient #20's medical record contained a discharge summary completed within 30 days after discharge.

Medical Record Staff B interviewed on 8/25/15 at 3:20 PM acknowledged the discharge summaries for patient #'s 4, 6, and 20 were not completed within 14 days after discharging the patient as required by their Medical Staff Rules and Regulations. Staff B acknowledged the history and physical assessments were not completed and signed within 48 hours after admission for patient #'s 11,12,14,15,16, and 17.