HospitalInspections.org

Based on policy review, personnel file review, medical record review, and interviews, the facility failed to assign competent nursing personnel to meet the needs of one patient (#3) of ten patients reviewed.

The findings included:

Review of the facility's Collection of Blood Culture Specimens policy dated 6/2015 revealed, "...When blood cultures are ordered x2 (times two), collect fom two different sites. If the same site is being used, you must wait 30 minutes between collecting each specimen..."

Review of Patient Care Technician (PCT) #1's personnel file revealed he last recieved training on collecting blood culture specimens on 9/24/12. Further review of PCT #1's blood culture specimen collection training revealed, "...if collecting from the same site you must wait 30 minutes between collecting sets of cultures..."

Medical record review of Patient #3's Emergency Room (ER) record revealed she presented to the ER on 4/6/15 at 2:43 PM, with complaints of Asthma and Fever. Further review of the medical records revealed the patient had two blood culture specimens collected on 4/6/15 by PCT #1, from undocumented sites, ten minutes apart at 3:28 PM and 3:38 PM.

Telephone interview with Patient #3 on 7/9/15 at 9:45 AM, revealed she remembered having blood culture specimens being collected on 4/6/15 by PCT #1. Further interview with Patient #3 revealed the PCT performed venipuncture (inserting a needle into a vein to obtain a blood specimen) upon her only one time and collected both blood cultures specimens at the same time and from the same venipuncture site. Further interview confirmed the patient did not have any other venipunctures or specimens collected during the ER admission on 4/6/15.

Interview with PCT #1 on 7/8/15 at 9:45 AM, in the administration conference room, revealed he would wait "...5 to 10 minutes to collect blood from the same site if no other site was available..."

Interview with the Laboratory Director on 7/8/15 at 9:20 AM, in the administration conference room, revealed, "...if you have to use the same sight to collect both blood culture specimens, then you must wait 30 minutes between sticks..."


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