HospitalInspections.org

Based on observation document review and interview, the facility did not ensure (a)Insulin syringes, phlebotomy needles, Angiocatheters {catheters and needles used to access intravenous lines}, and (b) patient medications were secured and not accessible in-patient care areas.

These lapses in environmental safety placed patients and visitors at increased safety risk.

Findings pertinent to A:

Observations in the facility's Medical Surgical/ Telemetry units during a tour between 12:50 PM and 2:00PM on 10/7/20 identified the following:

A medication cart was observed in the hallway near the nursing station unlocked, open and unattended with access to angiocatheters and needles, accessible to individuals walking by.

A bag of angiocatheters was noted hanging on a medication cart in the hallway, outside patient room # 4505, unsecured and unattended, accessible to individuals walking by.

In room # 4503, Phlebotomy needles were observed on a patient's bedside table unsecured and unattended.

Similar findings of unsecured and unattended syringes and angiocathers were observed on nursing supply carts in hallways.

These observations were made in the presence of Staff B (Regulatory Affairs), who confirmed the angiocatheters, needles and syringes should have been secured.

The facility policy and procedures (P&P) titled "Storage of Sharps, Syringes and Needles," last reviewed July 2020, contained the following statements: NYU Langone Hospitals stores all clean sharps, needles and syringes in a secured area to prevent diversion of these items in any unauthorized manner. The secured area can include a mobile storage unit (e.g. locked medication cart, secured medication drawers) or a separate secured room (e.g. locked clean medication room).

Findings pertinent to B:

Observations in the facility's Medical Surgical/ Telemetry units during a tour between 12:50PM and 2:00PM on 10/7/20 identified the following:

A box of Ventolin {medication used to treat patients with breathing problems} was observed on a medication cart in the hallway unsecured and unattended.

A medication cart with patient medications unlocked and unattended was noted in the hallway, accessible to individuals passing by.

Similar findings of unlocked patient medication carts were observed in hallways unsecured and unattended.

The facility policy and procedures titled "Medication Storage and Security," last reissued October 2020, contained the following statements: "Prescriptions and Non-Prescription Medications that are not controlled substances are dispensed from the Pharmacy and are stored only in areas with appropriated security to include: Locked medication carts, locked drawers or cabinets...locked medications room ..."

Based on observation, document review and interview, in three (4) of nine (13) observations of patients receiving intravenous (IV) medications, the nursing staff did not ensure the IV tubing were labeled indicating when the tubing's required changing.

This lapse in IV Tube labeling potentially placed patients at increased risk for infection.

Findings:
Observations in the facility's Medical Surgical/ Telemetry units during a tour on 10/7/20, and 10/8/20 identified the following:

On 10/7/20 at 1:03PM, Patient# 24, was observed receiving IV fluids and antibiotics via a primary tubing and two IV piggyback tubing's that were not labeled with the due dates indicating when the tubing required changing.

On 10/8/20, at 11:45 AM, Patient# 28 was observed receiving IV antibiotics via a primary tubing that was not labeled with the due dates, indicating when the tubing required changing.

Similar findings of failure to label IV tubing for patients receiving IV medications were observed for patients# 22 and 23.

These observations were made in the presence of Staff B (Regulatory Affairs), who confirmed the IV tubing's should have been labeled.

The facility policy and procedures titled "Peripheral Intravenous Access, Management of the Patient," last revised September 2020, lacked specific instructions directing the nursing staff to label IV tubing.

During interview of Staff O (Director of Nursing Education) on 10/13/20 at 2:00PM, she stated that it's implied during Nursing orientation and training that the IV tubing should be labeled.

Based on observation, document review and interview, the facility did not ensure staff adhered to acceptable standards of infection control practices with (A) hand hygiene and (B) IV medication administration.
These lapses in infection prevention placed patients, visitors and staff at increased risk for infections.

Findings pertinent to A:

During observations in the facility's Medical Intensive Care Unit (MICU)/ Surgical Intensive Care Unit (SICU) on 10/7/20 at 11:48AM, Staff F (Nursing Assistant), was observed preforming blood glucose testing on Patient #20.
The staff member removed her contaminated gloves twice during the process and without performing hand hygiene, retrieved new gloves from a box located in the patient's room and donned them.

On 10/8/20 at 11:45AM, Staff L (Registered Nurse), was observed administering an IV antibiotic medication to Patient #28. The staff member removed his gloves after connecting the patient to the medication then failed to perform hand hygiene after patient contact.

On 10/8/20 at 10:35AM, Staff H (Physician), was observed during the preparation of Patient #34 for a C-Section. The staff member removed her gloves after touching the patient and without performing hand hygiene, retrieving new gloves from a box and donned them.

Similar findings of the failure to perform hand hygiene after removing dirty gloves after patient contact was observed for Staff I (Registered Nurse).

These observations were made in the presence of Staff B, who confirmed the findings.

The facility policy and procedures titled "Hand Hygiene including Finger Nail enhancements," last reviewed June 2020, directed staff to do the following: "Hand hygiene ...indications for performing hand hygiene, which are: before and after patient contact, after contact with the patient's environment, before invasive procedures, after removing gloves and when hands come in contact with blood and body fluids and /or are visibly soiled."

Findings pertinent B:

Observations of Staff L, on 10/8/20 at 11:45AM, identified the following:
The Staff L (Registered Nurse), was observed administering an IV antibiotic medication to Patient #28.
Staff L primed the medication without the cap on at the end of the IV tubing. Covered the end of the tubing with his closed fist. He retrieved a flush from his pants pocket. Uncapped the flush, primed the flush and without disinfecting the Peripheral IV line or the end of the IV tubing and after touching the patient with the open tip of the flush of normal saline, flushed the peripheral IV lock and connected the patient to the IV antibiotic.

During interview of Staff L, at the time of the observation, he acknowledged the findings.

This was also observed in the presence of Staff B, who confirmed the findings.

Per interview of Staff O, (Director of Nursing Education) on 10/13/20 at 2:00PM, she stated that Nursing Staff receive training regarding aseptic technique and IV medication administration during orientation and competencies. She acknowledged that the staff member should have disinfected the end of the IV tubing and scrubbed the needless access prior to flushing the Peripheral IV line and connecting the IV antibiotic to the patient.

The facility policy and procedures titled "Peripheral Intravenous Access, Management of the Patient with" last September 2020, contained the following statement: "The Needless access valve must be scrubbed with alcohol for 10 seconds and fully dried prior to accessing the line."

Based on the observation, document review and staff interview the facility failed to provide a functional and sanitary environment for the provision of surgical services. Each operating room (OR) must be designed and equipped so that the types of surgery conducted can be performed in a manner that protects the lives and assures the physical safety of all individuals in the area. Failure to maintain positive air pressure in OR's relation to corridor may lead to entering of contaminants which may cause a breach in the infection control.

Findings include:

According to CDC guidelines, Operating rooms should be maintained at positive pressure with respect to corridors and adjacent areas.

The hospital policy and procedure for "Infection Control Risk Assessment: HVAC Monitoring and Allowed Procedure by Room type" revised on 10/19, states that "...Operating Rooms pressure relationship should be monitored daily by Unit leadership..." and "... to accommodate time limited excursions outside the established room to corridor pressure differential related to room cleaning or patient movement, the flex range for operating and procedure rooms to corridor pressure is 30 minutes."

However, during the tour of OR suite on 10/9/2020 between 10:30 am to 12:00 pm, it was observed that only temperature and relative humidity are continuously monitored electronically by building management system.

Review of documents on 10/9/2020 at 2:00 pm, noted that only temperature and relative humidity are monitored daily. The pressure relationship was monitored only quarterly.

Per interview of the Staff N (Assistant Director of Engineering) on 10/13/2020 at 10:45 am, he acknowledged the above finding and stated that the last pressure monitoring was done on 9/8/20 by Evergreen medical services.

The above finding was brought to the attention of facility's administration during the onsite exit conference on 10/13/2020.