HospitalInspections.org

Based on a review of 10 closed medical records, along with the hospital medical staff by-laws, it was determined that one patient's discharge summary did not meet either the requirements of this standard or the hospital's own policy.

Patient# 1 was a 49 year-old female admitted on 3/19/11 with weakness, vomiting, and diarrhea. She was determined to be in acute renal failure with metabolic derangements and was withdrawing from long term heavy alcohol abuse. Her condition continued to deteriorate, and after 20 days in the intensive care unit, the patient was transferred to a tertiary care center for continued treatment on 4/8/11.

Review of the patient's medical record failed to identify a transfer or discharge summary. Scrawled across the face-sheet was an unsigned note to "see transfer note." The last progress note entered by the physician included the patient ' s last set of laboratory results including cultures, current medication list, current ventilator settings, and current physical examination. The note also contains a list of five facilities contacted by the physician for possible transfer. Three facilities had accepted the patient and the note indicates that she would be transported by helicopter.

This note fails to meet standards for the following reasons: This patient had a very complicated course with multiple diagnostic and interventional procedures, none of which are delineated in the note, nor are results attached. For instance, the patient underwent a surgical tracheostomy on 3/29/11 and was started on hemodialysis, neither are reflected in the transfer note. The note is a snapshot of the patient's condition on the day of transfer and does not describe her condition on admission or the course of her hospitalization. The patient was being followed by Gastroenterology, Nephrology, Infectious Disease, Cardiology, and Surgery and none of the consults are attached nor is there reference to the content of the consults. While the most recent labs and culture results are included, there is no indication of treatments or medications attempted and the patient ' s response to them.

Neither the receiving facility nor the receiving physician are indicated, and there is no indication that a verbal report was given. The information that was sent with the patient in the form of this transfer note is inadequate for ensuring continuity of care and fails to meet standards.

Based on the deficiencies noted during the Life Safety Code survey and with , it was determined that the Condition of the Physical Environment was not met as evidenced by the standard level deficiencies cited at:

1. K017 indicating that partitions and ceilings were not resistant to the passage of smoke due to holes and other breaks;

1. K029 due to the failure to store combustible items safely;

3. K 034 due to the failure to correctly identify stairways;

4. K038 due to the failure to maintain exit access;

5. K039 and K072 for the failure to maintain corridors clear of obstructions;

6. K051 due to failure to install a smoke or heat detector in the area of the Fire alarm system;

7. K056 due to failure to provide complete coverage by the sprinkler system to all required areas;
8. K062 due to failure to test the automatic sprinkler and standpipe system in some areas of the building;
9. K066 due to the failure to enforce outdoor smoking areas;
10. K070 due to the use of electric space heaters in some office and patient areas;
11. K075 due to the use of trash receptacles exceeding 32 gallons for combustible materials;
12. K147 due to the failure to install GFCI receptacles within 6 feet of a water and the use of strip outlets and temporary wiring that was not compliant with NFPA 70, and
13. A724 for the continued use of a walk-in refrigerator for food storage where the food was potentially subject to water seepage from a roof leak.

Based on observation while on tour with the food service and facilities managers and interview with facility staff, it was determined that the facility failed to maintain kitchen equipment, plumbing and storage areas in a way that ensures food is prepared under sanitary and safe conditions. The findings include:

On October 31, 2011 at 10:00 AM, a building tour was conducted, including an inspection of the facility food service department. The following observations were made:
1) Water was observed dripping from the walk in refrigerator ceiling, directly above containers filled with salad bar ingredients. The containers of various raw vegetables were covered with plastic wrap. The surveyor notified the food service director who directed that the foods subject to possible contamination were discarded.
2) The dishwasher, two and three compartment sinks were installed without the required plumbing air gap between the waste lines and the building sewage lines. Plumbing fixtures that may contact food or food contact equipment must not have a direct connection to waste water to prevent contamination in case of a possible sewage backup.
3) A drain plunger was observed sitting on the edge of a two compartment food preparation sink.
4) Employees' personal foods, including 3 beverages and two lunch satchels, were observed intermingled with food for public service. Personal items may not be stored in these refrigeration units.
5.) A spray hose installed above the garbage disposal was observed to be hanging below the flood rim for the garbage disposal rinse table. The spring loaded device should have held the spray nozzle end above this flood line to prevent possible back flow of soiled water into the fresh water supply of the kitchen. This could occur if there is a drop in water pressure in the building.

Based on observations made during a tour of the food service area it was determined that temperature monitoring related to several freezer and refrigeration units did not meet requirements as evidenced by:
1. Two refrigeration units were observed with multiple thermometers that had different temperature readings, varying as much as 20 degrees Fahrenheit. Properly calibrated, accurate and conspicuous thermometers are required in all units that contain potentially hazardous foods.
2. Freezers in dry storage and the refrigeration unit at the coffee bar were determined to be domestic, not commercial quality. Refrigeration units must be certified adequate for commercial use by NSF or another approved outside certification source.