HospitalInspections.org

Based on observation, policy and document review and staff interview the Critical Access Hospital (CAH) failed to keep accurate records for narcotics in the Emergency Room (ER) and assure biologicals are not available for patient use in 1 of 1 fluid warming cabinets.

Findings include:

- The hospital's policy "Controlled Substances" reviewed on 1/4/11 at 8:50am directed nursing staff to account for all narcotic medications at the end of each shift by documenting on the hospital's narcotic count record.

- Observation of the locked medication cabinet in ER on 1/3/11 at 11:10am revealed it contained the following medications: ten-Morphine Sulfate syringes (a narcotic substance used to relieve pain) two milligrams (mg) per one millimeter, eight-Morphine Sulfate syringes ten mg per one milliliter, and eight-Demerol syringes (a narcotic substance used to relieve pain) 50mg per one milliliter. The hospital's nursing staff failed to follow hospital policy to count and document the amount of narcotics at the end of each shift in the ER.

Staff B interviewed on 1/3/11 at 11:40am reported pharmacy staff checked the narcotics in the ER monthly. Staff B acknowledged nursing staff failed to keep an accurate record of narcotics in the ER.

- Review on 1/5/11 at 2:15pm information provided by the manufacturer regarding the proper storage of irrigation fluids, indicates solutions for irrigation may be warmed to 104 degrees Fahrenheit for a period no longer than two weeks (14days).

- Observation on 1/3/11 at 12:10pm revealed a fluid warming cabinet in the sub sterile area of the procedure room area. The temperature in the upper compartment of the warming cabinet registered 150 degrees Fahrenheit 46 degrees above the recommended temperature. The upper compartment of the warming cabinet contained the following:
Two-1,500 cubic centimeters (cc) rigid plastic bottles of normal saline for irrigation.
Two- 500cc rigid plastic bottles of sterile water.

The bottles of irrigation solution lacked a date when staff placed the bottles in the warmer or when to remove them from use.

Staff A interviewed on 11/3/11 at 12:10am was unaware of the manufactures requirement to dispose of fluids in the warmer longer than two weeks.

Staff B interviewed on 11/3/11 at 2:10pm confirmed fluids are only removed from the warmer if used or reach the expiration date if stored at room temperature.

Based on policy review, record review, and staff interview, the Critical Access Hospital (CAH) failed to include all disciplines at their weekly Interdisciplinary care plan for 4 of 5 swing bed patients records reviewed (#14, 16, 17, 18).

Findings include:

- Review of the policy on 1/5/11 at 3:45pm titled, " Multidisciplinary Plan of Care " states, " ...the multidisciplinary plan of care of the responsibility of the multidisciplinary team ...the team will meet at least weekly to review the plan and patient progress within the plan ... "

- Review on 1/5/11 at 3:45pm of the procedure for the multidisciplinary care plan conference, directed staff that a weekly multidisciplinary care plan conference will be held, each member of the multidisciplinary care team will contribute to the planning of the swing bed patient care and goals, and each member of the multidisciplinary care team will sign the multidisciplinary care plan conference form.

- Patient #14 's medical record reviewed on 1/3/11 at 11:10am revealed an admission date of 1/3/11 with a diagnoses of after care injury/trauma skull fracture and dementia. The patient received physical therapy and social services during the swing bed stay. The clinical record lacked evidence physical therapy and/or social service participated in the weekly interdisciplinary care plan meetings.

- Patient #16 's medical record reviewed on 1/3/11 at 1:45pm revealed an admission date of 1/1/11 with diagnoses of pneumonia (an infection in the lungs) and hypertension (high blood pressure). The clinical record lacked evidence social service participated in the weekly interdisciplinary care plan meetings.

- Patient #17 's medical record reviewed on 1/4/11 at 9:40am revealed an admission date of 12/28/10 with diagnoses of dehydration, depression and memory loss. The clinical record lacked evidence social service participated in the weekly interdisciplinary care plan meetings.

- Patient #18 's closed medical record reviewed on 1/4/11 at 1:10pm revealed an admission date of 10/28/10 with diagnoses of status post fracture of left femur (leg bone), chronic obstructive pulmonary disease, decubitus ulceration (pressure sore) and hypertension (high blood pressure) and a discharge date of 11/6/10. The patient received physical therapy and social services during the swing bed stay. The clinical record lacked evidence physical therapy and/or social service participated in the weekly interdisciplinary care plan meetings.

Staff A interviewed on 1/5/11 at 12:40pm confirmed the CAH failed to follow their policy and procedure and lacked all disciplines at the weekly multidisciplinary care plan meeting.