HospitalInspections.org

Based on record review and interview, the nursing staff failed to administer medications in accordance with hospital policies and procedures by failing to conduct pain assessments prior to and after the administration of pain medication for 2 of 2 patients reviewed for PRN pain medications in a total sample of 30. (Patient #25, 28).
Findings:

Review of the hospital's policy and procedure for pain management revealed in part that a Pre and Post Pain Assessment must be performed when administering PRN pain medication.

Patient #25
Review of the medical record for patient #25 revealed she was admitted to the hospital on 01/28/19 with orders for Fioricet, one tablet every 6 hours PRN pain. Review of the Medication Administration Record revealed the patient received Fioricet on the following dates:
01/28/19 at 2:26 p.m. - no documented pain assessment prior to or after medication administration
01/28/19 at 9:47 p.m. - no documented pain assessment prior to medication administration
01/29/19 at 8:58 a.m. - no documented pain assessment prior to medication administration
01/29/19 at 5:36 p.m. - no documented pain assessment prior to or after medication administration
01/30/19 at 8:00 a.m. - no documented pain assessment prior to or after medication administration

On 02/13/19 at 10:00 a.m., S2DON reviewed the patient's electronic record and confirmed that there was no documented pain assessments prior to and after each PRN Fioriet administration. S2DON further confirmed that the hospital had no policy indicating time frames for pain assessments related to PRN medications.

Patient #28
Review of the medical record for patient #28 revealed he was admitted to the hospital on 02/05/19 with orders for Torodol 30mg intravenous every six hours PRN pain. Review of the Medication Administration Record revealed the patient received Torodol on the following dates:
02/05/19 at 5:53 p.m. - no documented pain assessment after medication administration
02/06/19 at 12:02 a.m. - no documented pain assessment after medication administration
02/06/19 at 6:00 a.m. - no documented pain assessment after medication administration
02/06/19 at 12:29 p.m. - no documented pain assessment prior to medication administration

On 02/13/19 at 10:30 a.m., S2DON reviewed the patient's electronic record and confirmed that there was no documented pain assessments prior to and/or after each PRN Torodol administration.

Based on policy review, observation and interview, the hospital failed to ensure outdated, mislabeled, or otherwise unusable drugs and biologicals were not available for patient use by having expired or unusable drugs, biologials and supplies available for patient use in crash carts, the medication storage area and the procedure cart.
Findings:

Review of the hospital's policy titled, "Opened Multi-dose Vials of Medication revealed in part:
Upon opening a multi-dose vial of medication the nurse will date and initial the vial. Proper cleansing of the vial stopper must be adhered to and the vial must be discarded 1 month after initially opening the vial.

On 02/11/19 at 11:00 a.m., observation of the crash cart on the acute care unit revealed two bags of 0.9% NaCl 1000cc expired in December 2018.

On 02/11/19 at 11:10 a.m., observation of the medication storage area of the acute care unit revealed 11 bags of D5W 1000cc expired in November 2018.

On 02/11/19 at 11:10 a.m., an interview with S2DON confirmed that the bags of NaCl on the crash cart and the bags of D5W in the medication storage room were available for patient use and should have been removed.

Observation of the rehabilitation unit's procedure cart on 02/12/2019 at 9:00 a.m. revealed the following:
a) 1- Bottle of Ibuprofen open and not dated.
b) 1- Diclofenac Sodium topical gel 1% open and not dated.
c) 1- Sterile cotton applicator in an open package.
d) 1- Bottle Accu-check performance test strips open and not dated.

Observation of the rehabilitation unit's crash cart on 02/12/2019 at 9:15 a.m. revealed the following:
a) 3 - Epinephrine 1mg/10ml injectable syringes with an expiration date of 1/February 2019.
b) 2- Adult Vivid Trac intubation devices with an expiration dated on January 2019.
c) 1- Combitube with and expiration date of 02-2017.
d) 1- Liter of Lactated Ringers solution with an expiration date of 01/2019.

During an interview on 02/12/2019 at 9:30 a.m., S2DON confirmed the findings for the rehabilitation unit's procedure cart and their crash cart.


20310

Based on observation and interview, the hospital failed to ensure equipment was maintained to ensure an acceptable level of safety as evidenced by having non-functioning nurse call bells located on the side rails of 47 of 47 patient beds.
Findings:

On 02/11/19 at 10:40 a.m., observation of patient room a revealed a nurse call button on the bed side rail which did not function when activation was attempted.

An interview with S2DON at this time revealed that all 47 patient beds in the facility had the visible non-functioning nurse call button features on the side rail. She confirmed that the currently functioning call system was the call bells that were attached to cords plugged into the wall and clipped to the bed linens. She further confirmed that the non-functioning call bells on the side rails could cause confusion for a patient or family member who was attempting to call for assistance.

Based on policy review, observation and interview, the hospital failed to have an effective system for controlling infections and communicable diseases as evidenced by failing to maintain a sanitary environment.
Findings:

Review of the Hospital's Policy titled "Storage of Clean/Sterile Supplies" revealed in part:
Clean and sterile supplies will be marked by covering with a plastic bag and must be stored in an area designated for that purpose only.

Observation on 02/11/2019 at 10:10 a.m., revealed 4 dirty feeding tube pumps and portable poles stored together with clean infusion pumps. The feeding pumps were not covered with plastic bags and their was visible grime on the surfaces of the pumps.

During an interview on 02/11/19 at 10:14 a.m., S2DON acknowledged the dirty feeding pumps and confirmed they should not have been stored with the clean infusion pumps.

On 02/12/19 at 10:30 a.m., observation of the kitchen with S3Dietary Manager revealed the following:
- The ice machine had a large build up of a black substance on the inside lid and sides. At that time, S3Dietary Manager wiped the black substance off with a rag and stated that it was mold. Further observations of the ice machine revealed the vent was coated with thick build up of dust.
- Observation of the stacked clean patient plates revealed three plates had old dried food on them.
- There was a box fan coated with dust that was blowing over the clean dishes in the diswasher room.

On 02/12/19 at 10:45 a.m., observation revealed S4Dietary Staff was washing dishes at the dishwashing machine. At that time, the surveyor asked the worker to perform a check of the sanitizer. At that time, she placed a test strip in the dishwasher but it did not register any sanitizer. S4Dietary Staff did this multiple times, but no sanitizer was registering. On 02/12/19 at 3:00 p.m., interview with S4Dietary Staff revealed that she had used the wrong strips on the dishwasher to test the sanitizer. Observations at that time revealed that the test strip was registering sanitizer.

On 02/12/19 at 10:55 a.m., the surveyor asked S3Dietary Manager to check the sanitizer at the three-compartment sink. S3Dietary Manager filled the sink with water and attempted to test the sanitizer with a test strip but it was not registering. Multiple attempts revealed no result. At that time, S3Dietary Manager stated that the chemical representative had been to the hospital last week checking on this same issue, but she thought it was fixed.